diff --git "a/Text_summarization/task78_mimic_ultrasound_summarization.json" "b/Text_summarization/task78_mimic_ultrasound_summarization.json" new file mode 100644--- /dev/null +++ "b/Text_summarization/task78_mimic_ultrasound_summarization.json" @@ -0,0 +1,9954 @@ +{ + "Contributors": "MIMIC", + "Source": "MIMIC-IV", + "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/", + "Categories": [ + "Summarization" + ], + "Definition": [ + "Given the detailed finding of Ultrasound imaging diagnostics, summarize the note's conclusion in a few words." + ], + "Reasoning": [], + "Input_language": [ + "English" + ], + "Output_language": [ + "English" + ], + "Instruction_language": [ + "English" + ], + "Domains": [ + "Medicine", + "Clinical Reports", + "Ultrasound" + ], + "Positive Examples": [], + "Negative Examples": [], + "Instances": [ + { + "input": "Minimal intra-abdominal fluid was observed within the right and left lower\nquadrants as well as adjacent to the bladder.", + "output": "Minimal ascites. No paracentesis was performed." + }, + { + "input": "There is a single live intrauterine gestation in cephalic presentation. The\ncervix measures 3 cm in length. An anterior placenta is noted with no\nevidence of abruption at this time. The uterus has a normal gravid\nappearance.\n\nThe right ovary is poorly visualized however, grossly normal in appearance. \nDilated, patent veins are evident in the right adnexa measuring up to 14 mm in\ndiameter.\n\nThe left ovary has a normal appearance, is normal in size, and demonstrates\narterial and venous flow with color and spectral Doppler. Immediately\nadjacent to the left ovary, there continues to be an oblong simple cyst which\nmeasures 6.7 x 3.4 x 6.2 cm, previously 6.6 x 3.7 x 6.3 cm. There is no\ninternal vascularity or nodularity demonstrated within this cyst.", + "output": "1. Single live intrauterine gestation.\n2. Stable simple left adnexal cyst which is unchanged in size and appearance\nwhen compared to prior ultrasound. Recommend follow-up ultrasound after the\nbaby is born\n3. Normal appearing left ovary adjacent to the simple left adnexal cyst with\nno sonographic evidence of torsion .\n4. Dilated, patent right adnexal vessels.\n5. Poorly visualized right ovary however, grossly normal in appearance.\n\nNOTIFICATION: The findings were discussed with ___, R.N. In OB triage by\n___ on the telephone on ___ at 3:23 pm, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 67 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 124, 95, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 2.1.\nThe external carotid artery has peak systolic velocity of 166 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 70 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 124, 81, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.8.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "40-59% stenosis of the right internal carotid artery.\n40-59% stenosis of the left internal carotid artery." + }, + { + "input": "At 3 o'clock 3 cm from nipple a benign-appearing cluster of cysts was again\nidentified.\n\nAt 12 o'clock 6 cm from nipple there is re-demonstration of a hypoechoic ovoid\nparallel mass without internal vascular which has increased in size in the\ninterval and appears more heterogeneous since prior studies. It now measures\n2.5 by 1.0 x 2 cm this mass measured 1.8 cm in the greatest diameter in ___..\nUltrasound-guided biopsy of this lesion is recommended.\n\nAt 12 o'clock 3 cm from nipple there is a stable ovoid hypoechoic mass\nmeasuring 1.2 by 1.3 x 0.8 cm. At 11:30 3 cm from nipple there is\nre-demonstration of a hypoechoic ovoid mass measuring 0.9 x 0.5 x 0.7 cm. \nThis is stable.\n\nThere is an ovoid parallel mass at 11 o'clock 3 cm from nipple which has not\nbeen previously imaged. This measures 1.3 x 1.3 x 0.4 cm.", + "output": "Interval increase in the size and heterogeneity the 12 o'clock 6 cm from\nnipple mass for which ultrasound-guided biopsy is recommended.\n\n Stable appearance of the 12 o'clock 3 cm from nipple and 11:30 3 cm from\nnipple masses for ___ year interval consistent with benign findings.\n\nNot previously identified/imaged mass at 11 o'clock 3 cm from nipple for which\nsix-month follow-up is recommended assuming the biopsy results are benign.\n\nRECOMMENDATION(S): Left breast ultrasound-guided biopsy\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan. She was given information to schedule her\nbiopsy.\n The findings were emailed to Alex___, by ___, M.D. on\n___ at 9:19 am.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Preprocedure imaging re-demonstrates a left breast 2.5 x 1.1 x 2.4 cm oval\nhypoechoic mass at 12 o'clock 6 cm from the nipple which was the target for\nultrasound core biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the left\nbreast 12 o'clock mass and using a 14-gauge Bard spring-loaded biopsy device,\n5 cores were obtained. Next, a percutaneous ribbon clip was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nLEFT BREAST POST-PROCEDURE MAMMOGRAM: CC and lateral views confirm\nappropriate clip placement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Preprocedure imaging re-demonstrates a left breast 2.5 x 1.1 x 2.4 cm oval\nhypoechoic mass at 12 o'clock 6 cm from the nipple which was the target for\nultrasound core biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the left\nbreast 12 o'clock mass and using a 14-gauge Bard spring-loaded biopsy device,\n5 cores were obtained. Next, a percutaneous ribbon clip was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nLEFT BREAST POST-PROCEDURE MAMMOGRAM: CC and lateral views confirm\nappropriate clip placement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 71, 84, and 79 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 29\ncm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 105 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 89 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 95, 77, and 62 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 23\ncm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant plaque or stenosis in the internal carotid\narteries" + }, + { + "input": "Targeted ultrasound in the region of the patient's pain, in the lateral right\nlower quadrant, was performed. Transverse and sagittal images were obtained\nwhich demonstrate no sonographic abnormalities. The appendix could not be\nvisualized. Peristalsing bowel is demonstrated in the region.", + "output": "Nonvisualization of the appendix however, no sonographic abnormalities are\ndemonstrated in the region of the patient's discomfort." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n5 mm circumscribed mass is re-demonstrated in the upper outer right breast. \nFurther evaluation will be performed with ultrasound. No additional\nabnormalities are identified in the right breast.\n\nBREAST ULTRASOUND: At 9 o'clock 5 cm from the nipple there is a normal lymph\nnode. This corresponds well to the mammographic finding.", + "output": "Right breast mass corresponds to normal lymph node.\n\nRECOMMENDATION(S): Return to screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n5 mm circumscribed mass is re-demonstrated in the upper outer right breast. \nFurther evaluation will be performed with ultrasound. No additional\nabnormalities are identified in the right breast.\n\nBREAST ULTRASOUND: At 9 o'clock 5 cm from the nipple there is a normal lymph\nnode. This corresponds well to the mammographic finding.", + "output": "Right breast mass corresponds to normal lymph node.\n\nRECOMMENDATION(S): Return to screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 80, 73, and 66 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.80.\nThe external carotid artery has peak systolic velocity of 109 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has severe homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 145, 221, and 72 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 74 cm/sec.\nThe ICA/CCA ratio is 2.1.\nThe external carotid artery has peak systolic velocity of 115 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Severe homogeneous plaque within the left internal carotid artery, with\nestimated 60-69% stenosis.\n2. Mild heterogeneous plaque within the right internal carotid artery, with\nestimated less than 40% stenosis." + }, + { + "input": "Abdominal wall collection measuring 1.6 by is 0.8 x 1.6 cm.", + "output": "1. Small abdominal wall collection.\n2. Successful US-guided aspiration into the anterior abdominal wall\ncollection. Sample was sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 61, 54, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 67 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 49 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 56, 57, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 134 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Findings consistent with less than 40% ICA stenosis bilaterally." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed again demonstrating the large mass, and a suitable\napproach targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the\nhyperechoic mass in the right lobe of the liver. 3 core biopsy samples were\nobtained and placed in formalin and sent for histopathology while an\nadditional sample was placed in saline and sent for requested microbiology. \nThe skin was then cleaned and a dry sterile dressing was applied. There was no\nimmediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 200 mcg fentanyl throughout the total intra-service time of 19\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Successful targeted liver biopsy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Parenchymal asymmetry is present in the right axilla\ndeep to the BB marker.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses. In the right axilla\nnormal-appearing echogenic parenchyma is identified.", + "output": "No evidence of malignancy. Benign accessory breast tissue right axilla,\naccounting for the palpable finding.\n\nRECOMMENDATION(S): Annual screening mammography is recommended. Continued\nclinical followup is advised.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Parenchymal asymmetry is present in the right axilla\ndeep to the BB marker.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses. In the right axilla\nnormal-appearing echogenic parenchyma is identified.", + "output": "No evidence of malignancy. Benign accessory breast tissue right axilla,\naccounting for the palpable finding.\n\nRECOMMENDATION(S): Annual screening mammography is recommended. Continued\nclinical followup is advised.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound the right breast at 9 o'clock 2 cm from the nipple\ndemonstrates a stable oval hypoechoic mass measuring 7 x 4 x 8 mm, without\nposterior shadowing. Some prominent vascularity is seen in the breast\nparenchyma anterior to the mass. The adjacent simple cyst is again noted. \nThe overall appearance of the hypoechoic masses similar to the prior\nultrasound and continued follow-up is recommended.", + "output": "Six-month stability of a 7 x 4 x 8 mm hypoechoic mass right breast 9 o'clock 2\ncm from the nipple. As noted previously this may correspond to a stable\nmammographic asymmetry seen since ___.\n\nRECOMMENDATION(S): Six-month follow-up bilateral diagnostic mammogram and\nright breast ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her followup. In\naddition, we discussed the option of ultrasound core biopsy which we decided\nagainst today, given the stability by ultrasound.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications.\n\nLeft breast: There was question of a focal asymmetry in the upper outer\nanterior left breast. Additional diagnostic views demonstrated this to be\ncompressible and likely representing overlap of glandular tissue.\n\nBILATERAL BREAST ULTRASOUND:\n\nRight breast: At 9 o'clock 2 cm from cyst nipple there is re-demonstration of\na hypoechoic mass measuring 0.6 x 0.4 x 0.8 cm. This has been stable for ___\nyear.\n\nLeft breast: Targeted sonography of the upper outer quadrant to assess for the\npreviously noted asymmetry did not demonstrate any sonographic abnormality. \nAt 3 o'clock there is a subcentimeter cyst which has been identified\npreviously both mammographically and sonographically.", + "output": "No mammographic evidence of malignancy.\n\nStable right breast hypoechoic mass at 9 o'clock. Continued follow-up is\nrecommended.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and right breast ultrasound\nin ___ year.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications.\n\nLeft breast: There was question of a focal asymmetry in the upper outer\nanterior left breast. Additional diagnostic views demonstrated this to be\ncompressible and likely representing overlap of glandular tissue.\n\nBILATERAL BREAST ULTRASOUND:\n\nRight breast: At 9 o'clock 2 cm from cyst nipple there is re-demonstration of\na hypoechoic mass measuring 0.6 x 0.4 x 0.8 cm. This has been stable for ___\nyear.\n\nLeft breast: Targeted sonography of the upper outer quadrant to assess for the\npreviously noted asymmetry did not demonstrate any sonographic abnormality. \nAt 3 o'clock there is a subcentimeter cyst which has been identified\npreviously both mammographically and sonographically.", + "output": "No mammographic evidence of malignancy.\n\nStable right breast hypoechoic mass at 9 o'clock. Continued follow-up is\nrecommended.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and right breast ultrasound\nin ___ year.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nRight: There is a 1.4 cm oval circumscribed mass in the central-medial\ninferior right breast corresponding to the 1.3 cm simple cyst identified on\nultrasound at 7 o'clock.\nThere is no discrete mass seen in the right lateral breast at 9 o'clock to\ncorrespond to the 7 mm hypoechoic mass which is now stable for ___ years\nconsistent with a benign entity.\nThere is a stable 9 mm oval asymmetry in the retroareolar region on the CC\nview only, similar to priors including ___ consistent with a benign finding.\nThere are no suspicious grouped calcifications.\n\nLeft: The left breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed.\nAt 9 o'clock 2 cm from the nipple is a stable oval 7 x 4 x 6 mm oval\nhypoechoic mass without dominant vascularity or posterior shadowing similar to\nthe priors including ___, consistent with a benign entity.\nAt 7 o'clock 2-3 cm from the nipple is a benign 1.3 cm simple cyst\ncorresponding to the finding seen on mammography in the central-medial\ninferior.", + "output": "No specific evidence of malignancy in either breast. ___ year stability of a 7\nmm benign-appearing right breast mass seen on ultrasound at 9 o'clock 2 cm\nfrom the nipple.\n\nRECOMMENDATION(S): Return to annual screening.\n\nNOTIFICATION: Findings and recommendation reviewed with the patient by the\ntechnologist at the completion of the exam. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nRight: There is a 1.4 cm oval circumscribed mass in the central-medial\ninferior right breast corresponding to the 1.3 cm simple cyst identified on\nultrasound at 7 o'clock.\nThere is no discrete mass seen in the right lateral breast at 9 o'clock to\ncorrespond to the 7 mm hypoechoic mass which is now stable for ___ years\nconsistent with a benign entity.\nThere is a stable 9 mm oval asymmetry in the retroareolar region on the CC\nview only, similar to priors including ___ consistent with a benign finding.\nThere are no suspicious grouped calcifications.\n\nLeft: The left breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed.\nAt 9 o'clock 2 cm from the nipple is a stable oval 7 x 4 x 6 mm oval\nhypoechoic mass without dominant vascularity or posterior shadowing similar to\nthe priors including ___, consistent with a benign entity.\nAt 7 o'clock 2-3 cm from the nipple is a benign 1.3 cm simple cyst\ncorresponding to the finding seen on mammography in the central-medial\ninferior.", + "output": "No specific evidence of malignancy in either breast. ___ year stability of a 7\nmm benign-appearing right breast mass seen on ultrasound at 9 o'clock 2 cm\nfrom the nipple.\n\nRECOMMENDATION(S): Return to annual screening.\n\nNOTIFICATION: Findings and recommendation reviewed with the patient by the\ntechnologist at the completion of the exam. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nAdditional views demonstrate persistence of a 6 x 3 mm oval circumscribed\nisodense focal asymmetry in the medial right breast at middle-posterior depth.\nOtherwise, the right breast is without suspicious dominant mass, architectural\ndistortion or suspicious grouped calcification.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right medial breast was\nperformed from 1 o'clock through 5 o'clock 0-10 cm from the nipple. There is\nno discrete mass seen in the medial right breast at 7-8 cm from the nipple to\ncorrespond to the mammographic finding. There is a prominent blood vessel at\nthis location which may be related to the finding.\n\nIncidentally seen at 3 o'clock 4-5 cm from the nipple is a bilobed\ncircumscribed hypoechoic mass measuring 6 x 4 x 4 mm with a thin internal\nseptation, without dominant vascularity or posterior shadowing. This has the\nappearance of a bilobed fibroadenoma.", + "output": "Probably benign 6 x 3 mm oval circumscribed focal asymmetry in the medial\nright breast without ultrasound correlate.\nIncidental, probably benign bilobed mass measuring 6 x 4 mm at 3 o'clock 4-5\ncm from the nipple without a mammogram correlate.\n\nRECOMMENDATION(S): Six-month follow-up right breast mammogram for the\nmammogram finding and six-month follow-up right breast ultrasound for the\nseparate ultrasound finding.\n\nNOTIFICATION: Findings and recommendation for follow-up were discussed with\nthe patient at the completion of the study. We also reviewed the option of\nbiopsy, however the fact that these look benign, and this was her first\nmammogram, six-month follow-up seems reasonable at this time. She was given\ninformation to schedule her followup appointments.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nAdditional views demonstrate persistence of a 6 x 3 mm oval circumscribed\nisodense focal asymmetry in the medial right breast at middle-posterior depth.\nOtherwise, the right breast is without suspicious dominant mass, architectural\ndistortion or suspicious grouped calcification.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right medial breast was\nperformed from 1 o'clock through 5 o'clock 0-10 cm from the nipple. There is\nno discrete mass seen in the medial right breast at 7-8 cm from the nipple to\ncorrespond to the mammographic finding. There is a prominent blood vessel at\nthis location which may be related to the finding.\n\nIncidentally seen at 3 o'clock 4-5 cm from the nipple is a bilobed\ncircumscribed hypoechoic mass measuring 6 x 4 x 4 mm with a thin internal\nseptation, without dominant vascularity or posterior shadowing. This has the\nappearance of a bilobed fibroadenoma.", + "output": "Probably benign 6 x 3 mm oval circumscribed focal asymmetry in the medial\nright breast without ultrasound correlate.\nIncidental, probably benign bilobed mass measuring 6 x 4 mm at 3 o'clock 4-5\ncm from the nipple without a mammogram correlate.\n\nRECOMMENDATION(S): Six-month follow-up right breast mammogram for the\nmammogram finding and six-month follow-up right breast ultrasound for the\nseparate ultrasound finding.\n\nNOTIFICATION: Findings and recommendation for follow-up were discussed with\nthe patient at the completion of the study. We also reviewed the option of\nbiopsy, however the fact that these look benign, and this was her first\nmammogram, six-month follow-up seems reasonable at this time. She was given\ninformation to schedule her followup appointments.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThe right breast parenchymal pattern remains stable with the subtle 6 x 3 mm\nisodense oval circumscribed asymmetry in the medial breast at middle to\nposterior depth similar to the prior studies. Otherwise, there is no\nsuspicious dominant mass, architectural distortion or suspicious grouped\ncalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at 3 o'clock\n4-5 cm from the nipple demonstrates a bilobed hypoechoic mass measuring 6 x 4\nx 4 mm, without dominant vascularity or posterior shadowing similar to the\nprior study.\nAs noted previously, this likely does not correspond to the mammographic\nfinding and there is no other abnormality identified in the more posterior\ntissue.", + "output": "Six-month stability of probably benign right breast findings seen on\nmammography and another area seen on ultrasound.\n\nRECOMMENDATION(S): Six-month bilateral diagnostic mammogram and right breast\nultrasound to confirm continued expected stability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThe right breast parenchymal pattern remains stable with the subtle 6 x 3 mm\nisodense oval circumscribed asymmetry in the medial breast at middle to\nposterior depth similar to the prior studies. Otherwise, there is no\nsuspicious dominant mass, architectural distortion or suspicious grouped\ncalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at 3 o'clock\n4-5 cm from the nipple demonstrates a bilobed hypoechoic mass measuring 6 x 4\nx 4 mm, without dominant vascularity or posterior shadowing similar to the\nprior study.\nAs noted previously, this likely does not correspond to the mammographic\nfinding and there is no other abnormality identified in the more posterior\ntissue.", + "output": "Six-month stability of probably benign right breast findings seen on\nmammography and another area seen on ultrasound.\n\nRECOMMENDATION(S): Six-month bilateral diagnostic mammogram and right breast\nultrasound to confirm continued expected stability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nAsymmetry in the medial right breast is stable for one year and probably\nbenign. Skin lesion projects over the central lower left breast. No\nadditional abnormalities are present in either breast.\n\nBREAST ULTRASOUND: At 3 o'clock 4 cm from the nipple there is\nre-demonstration of a 0.6 x 0.4 x 0.4 cm hypoechoic mass. This is an\nincidental ultrasound finding and has demonstrated one year stability.", + "output": "One year stability of the finding seen on mammography and ultrasound.\n\nRECOMMENDATION(S): Follow-up in one year is recommended with mammogram and\nultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\n There is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Since the patient had complained of a palpable finding\nit was marked on the skin. Additional spot compression views of this area\nwere normal.\n\nBILATERAL BREAST ULTRASOUND:\n\nRight breast: Initially the area of symptomatology as directed by the patient\nwas scanned which was within normal limits. This involved the lateral right\nbreast. No cystic or solid masses were identified. Subsequently there\nremainder of the right breast was scanned with negative results. Specifically\nat 9 o'clock 2 cm from nipple no abnormalities were identified (as stated on\nthe requisition).\n\nLeft breast: The entire left breast was scanned with negative results. \nSpecifically at 2 o'clock 2 cm from nipple no abnormalities are identified (as\nstated on the requisition).", + "output": "Mammographically dense breast without evidence of malignancy.\n\nBilateral whole breast ultrasound was within normal limits. Continued\nclinical evaluation of the patient's palpable complaint is recommended.\n\nRECOMMENDATION(S): Risk and age based screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy via an interpreter.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogenous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 44 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 44, 65, and 43 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 72 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 62, 70, and 79 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.33.\nThe external carotid artery has peak systolic velocity of 74 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral carotids with <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin the internal, external, and common carotid arteries.\nThe peak systolic velocity in the right common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 59, 65, and 85 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 56 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin the internal, external, and common carotid arteries.\nThe peak systolic velocity in the left common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 66, 59, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 53 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous atherosclerotic plaque within bilateral carotid arteries. \nHowever, there is no hemodynamically significant stenosis bilaterally (less\nthan 40%)." + }, + { + "input": "The uterus is anteverted and measures 4.4 x 2.7 x 3.6 cm. Small amount of\nfluid is demonstrated within the endometrial cavity and endocervical canal\nlikely representing some element of cervical stenosis. This outlines a\nhomogeneous endometrium measuring 2 mm in thickness.\n\nThe ovaries normal there are no adnexal masses identified.. There is no free\nfluid.", + "output": "Small amount of fluid demonstrated within the endometrial cavity and\nendocervical canal likely representing some element of cervical stenosis. \nNormal ovaries." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no evidence of architectural distortion, masses or suspicious grouped\nmicrocalcifications in either breast.\n\nBILATERAL BREAST ULTRASOUND: Scanning in the retroareolar regions of bilateral\nbreasts showed normal breast tissue without suspicious findings.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Clinical follow-up. The patient was advised to withhold\nfrom manually extracting discharge from her breasts.\nAge and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given the number to the ___, should\nshe experience worsening symptoms.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nCalcified plaque is seen in the right carotid bulb.\nThe peak systolic velocity in the right common carotid artery is 92 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 75, 92, and 89 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 95 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nMixed soft and hard plaque is seen in the left carotid bulb.\nThe peak systolic velocity in the left common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 77, 73, and 80 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 0.93.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Plaque seen bilaterally in the carotid bulbs however no hemodynamically\nsignificant stenosis is identified." + }, + { + "input": "Scanning in the region of the patient's palpable abnormalities in the region\nof the inguinal canals demonstrates bilateral inguinal hernias with Valsalva.\nOn the right, the neck of the hernia measures 13 mm. On the left, the neck of\nthe hernia measures 9.0 mm.", + "output": "Bilateral inguinal hernias." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 78 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 80, 74, and 66 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 1.\nThe external carotid artery has peak systolic velocity of 140 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 77, 64, and 84 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Normal examination." + }, + { + "input": "Under realtime ultrasound guidance, a target was marked. After administering\nlocal anesthesia, a needle was placed into the collection. Subsequently a\nwire is passed through the needle. After removing the needle, a catheter was\nplaced over the wire. Removing the wire, proximally 5 cc was aspirated. A\npost CT scan was performed to confirm positioning.\n\nOn the post scan the previously placed PTBD is also seen.\n\nThere is prominence of the right renal pelvis which is similar to MRCP from ___.\n\nA residual drain/stent is seen within the mid abdomen.", + "output": "Successful US-guided placement of an ___ pigtail catheter into the\ncollection. Samples were sent for microbiology evaluation." + }, + { + "input": "Targeted ultrasound of the gallbladder fundus reveals a perforation in the\ngallbladder wall, although the gallbladder remains partially distended. There\nis trace pericholecystic fluid. The gallbladder wall is thickened.", + "output": "1. Perforation of the gallbladder.\n2. Successful ultrasound-guided placement of ___ pigtail catheter into\nthe gallbladder. A sample was sent for microbiology evaluation.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\nsurgery via telephone on ___ prior to the procedure at 10:42, 5 minutes\nafter discovery of the findings. This was also communicated to Dr. ___\n___ medicine following the procedure at 12:20PM on ___." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no suspicious mass, grouped suspicious microcalcifications or\narchitectural distortion. A 6 mm reniform mass in the upper outer left breast\nwith radiolucent hilum corresponds to a benign appearing intramammary lymph\nnode.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast from ___ o'clock\n1-10 cm from the nipple, corresponding to the area of pain as indicated by the\npatient demonstrates no solid mass or cystic lesion. Further management of\nthe patient's symptoms at this time should be based on the clinical\nassessment.", + "output": "No focal sonographic or mammographic abnormality identified in the left breast\nin the area of pain as indicated by the patient. Further management of the\npatient's symptoms at this time should be based on the clinical assessment.\n\nRECOMMENDATION(S): Age and risk appropriate mammography. Clinical follow-up.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy in the presence of the patient's husband.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 2 18-gauge core biopsy passes were made. \nThe sample was provided to the on-site cytologist who indicated an adequate\nsample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n40 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen provided to\nthe cytologist." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. The liver is noted to be diffusely echogenic.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 15\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nA skin marker in the upper outer left breast denotes the site of focal pain as\nindicated by the patient. Underlying the skin marker, there is no\nmammographic abnormality. No worrisome mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications are seen in either\nbreast. Faint vascular calcifications are noted bilaterally.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of pain\nas indicated by the patient, which was without any discrete suspicious solid\nor cystic masses.", + "output": "No specific evidence of malignancy. No imaging abnormality to explain the\npatient's pain.\n\nRECOMMENDATION(S): Clinical followup for the patient's pain is recommended. \nOtherwise, she can return to routine screening in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy via an interpreter.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nWell-circumscribed nodule measuring 4 mm is identified in the left upper outer\nbreast. Ovoid nodule is identified in the right outer breast posteriorly. No\narchitectural distortion or suspicious microcalcifications are noted.\n\nBREAST ULTRASOUND: Evaluation of the outer portions of both breast were\nperformed in the areas of mammographic concern. On the right at 9 o'clock, 8\ncm from the nipple, there is a well-circumscribed ovoid anechoic cyst\nmeasuring 10 mm x 4 mm x 12 mm. No internal vascularity is seen.\nThe on the left at 1 o'clock, 5 cm from the nipple there is a\nwell-circumscribed rounded anechoic cyst measuring 4 mm x 4 mm x 4 mm. No\ninternal vascularity is seen. No posterior acoustic features are identified\non either nodule.", + "output": "Benign cysts accounting for the mammographic finding. No evidence malignancy.\n\nRECOMMENDATION(S): Annual screening is advised.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nWell-circumscribed nodule measuring 4 mm is identified in the left upper outer\nbreast. Ovoid nodule is identified in the right outer breast posteriorly. No\narchitectural distortion or suspicious microcalcifications are noted.\n\nBREAST ULTRASOUND: Evaluation of the outer portions of both breast were\nperformed in the areas of mammographic concern. On the right at 9 o'clock, 8\ncm from the nipple, there is a well-circumscribed ovoid anechoic cyst\nmeasuring 10 mm x 4 mm x 12 mm. No internal vascularity is seen.\nThe on the left at 1 o'clock, 5 cm from the nipple there is a\nwell-circumscribed rounded anechoic cyst measuring 4 mm x 4 mm x 4 mm. No\ninternal vascularity is seen. No posterior acoustic features are identified\non either nodule.", + "output": "Benign cysts accounting for the mammographic finding. No evidence malignancy.\n\nRECOMMENDATION(S): Annual screening is advised.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 71, 66, and 68 cm/sec, respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 0.86.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 89 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 66, 75, and 69 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 0.84.\nThe external carotid artery has peak systolic velocity of 51 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Normal carotid ultrasound." + }, + { + "input": "There is normal respiratory variation in both common femoral veins.\n\nThere is normal compressibility, flow and augmentation of both common femoral,\nfemoral, and popliteal veins. Normal color flow and compressibility is\ndemonstrated in the bilateral posterior tibial veins. The bilateral peroneal\nveins are not visualized. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis in the right or left lower extremity\nalthough the peroneal veins are not visualized." + }, + { + "input": "The right testicle measures: 4.6 x 2.6 x 2.8 cm.\nThe left testicle measures: 3.8 x 2.3 x 2.8 cm.\n\nThe testicular echogenicity is normal, without focal abnormalities.\nThe epididymides are normal bilaterally.\nVascularity is normal and symmetric in the testes and epididymides.\n\nIn the left testicle there is a heterogeneous partially echogenic collection\nthat measures 3.0 x 3.0 cm that corresponds with the site of swelling on\nphysical exam and is likely compatible with a scrotal hematoma.\n\nNo focal sonographic abnormalities are visualized in the penis.", + "output": "1. 3 cm heterogeneous collection in the left scrotum likely compatible with a\nscrotal hematoma.\n2. No focal testicular or penile abnormalities identified.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ in ___ ___ at 8:31 am, 30 minutes after discovery of the\nfindings." + }, + { + "input": "The right testicle measures: 4.6 x 2.6 x 2.8 cm.\nThe left testicle measures: 3.8 x 2.3 x 2.8 cm.\n\nThe testicular echogenicity is normal, without focal abnormalities.\nThe epididymides are normal bilaterally.\nVascularity is normal and symmetric in the testes and epididymides.\n\nIn the left testicle there is a heterogeneous partially echogenic collection\nthat measures 3.0 x 3.0 cm that corresponds with the site of swelling on\nphysical exam and is likely compatible with a scrotal hematoma.\n\nNo focal sonographic abnormalities are visualized in the penis.", + "output": "1. 3 cm heterogeneous collection in the left scrotum likely compatible with a\nscrotal hematoma.\n2. No focal testicular or penile abnormalities identified.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ in ___ ___ at 8:31 am, 30 minutes after discovery of the\nfindings." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the lower slightly inner right breast at anterior to middle depth in the\narea marked by metallic BB, there is an oval mass with irregular margins\nmeasuring 2.6 x 3.2 cm. Coarse calcifications are seen within the mass. \nThere is an asymmetry just medial to the dominant mass. There is no\nsuspicious architectural distortion or additional calcifications in the right\nbreast.\nIn the left breast, there are loosely grouped round calcifications in the\nslightly inner lower left breast at middle to posterior depth, in addition to\nsecond loosely grouped round calcifications in the middle of the breast at\nanterior depth. 2.1 cm retroareolar oval equal density mass in the left\nbreast is well-circumscribed. Intramammary lymph node is seen in the upper\nouter left breast at posterior depth. No architectural distortion is seen.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 4 o'clock, 3 cm\nfrom the nipple demonstrated heterogeneous predominantly solid\nirregularly-shaped, anti parallel mass with angular borders which demonstrated\nsignificant internal vascularity, measuring 2.9 x 3.1 x 2.4 cm, corresponding\nwith the mammographic abnormality. Central anechoic, cystic area and punctate\nechogenicity are noted within the mass. In addition, a satellite solid lesion\n1 cm posterior to the dominant mass is noted at 4 o'clock, 4 cm from the\nnipple, measuring 0.7 x 0.7 x 0.9 cm with peripheral vascularity. Ultrasound\nof the right axilla reveals normal lymph nodes.\n\nIn the left breast at 12 o'clock, 2 cm from the nipple, there is a simple cyst\nwith internal septation measuring 1.7 x 0.3 x 2.0 cm, corresponding with the\nmammographic mass.", + "output": "1. Suspicious mass in the right breast measuring 2.9 x 3.1 x 2.4 cm with\ninternal vascularity for which ultrasound-guided biopsy is recommended. \nSatellite lesion is seen approximately 1 cm posterior to the dominant mass and\ncorresponding with the mammographic abnormality.\n2. 2 loosely grouped calcifications in the left breast for which disposition\nwould depend on the biopsy result for further follow-up.\n3. Predominantly anechoic cyst with septation in the left breast for which no\nadditional follow-up is needed.\n\nRECOMMENDATION(S):\n1. Ultrasound-guided biopsy of the dominant right breast mass.\n2. Follow-up for left breast would depend on the biopsy result of the right\nbreast.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\nThe patient is scheduled for biopsy at 15:00 on ___.\n\n The findings and recommendations left in the voicemail at ___, M.D.'s\noffice by ___, M.D. on the telephone on ___ at 5:10 pm, 10\nminutes after discovery of the findings.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 17:13 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the lower slightly inner right breast at anterior to middle depth in the\narea marked by metallic BB, there is an oval mass with irregular margins\nmeasuring 2.6 x 3.2 cm. Coarse calcifications are seen within the mass. \nThere is an asymmetry just medial to the dominant mass. There is no\nsuspicious architectural distortion or additional calcifications in the right\nbreast.\nIn the left breast, there are loosely grouped round calcifications in the\nslightly inner lower left breast at middle to posterior depth, in addition to\nsecond loosely grouped round calcifications in the middle of the breast at\nanterior depth. 2.1 cm retroareolar oval equal density mass in the left\nbreast is well-circumscribed. Intramammary lymph node is seen in the upper\nouter left breast at posterior depth. No architectural distortion is seen.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 4 o'clock, 3 cm\nfrom the nipple demonstrated heterogeneous predominantly solid\nirregularly-shaped, anti parallel mass with angular borders which demonstrated\nsignificant internal vascularity, measuring 2.9 x 3.1 x 2.4 cm, corresponding\nwith the mammographic abnormality. Central anechoic, cystic area and punctate\nechogenicity are noted within the mass. In addition, a satellite solid lesion\n1 cm posterior to the dominant mass is noted at 4 o'clock, 4 cm from the\nnipple, measuring 0.7 x 0.7 x 0.9 cm with peripheral vascularity. Ultrasound\nof the right axilla reveals normal lymph nodes.\n\nIn the left breast at 12 o'clock, 2 cm from the nipple, there is a simple cyst\nwith internal septation measuring 1.7 x 0.3 x 2.0 cm, corresponding with the\nmammographic mass.", + "output": "1. Suspicious mass in the right breast measuring 2.9 x 3.1 x 2.4 cm with\ninternal vascularity for which ultrasound-guided biopsy is recommended. \nSatellite lesion is seen approximately 1 cm posterior to the dominant mass and\ncorresponding with the mammographic abnormality.\n2. 2 loosely grouped calcifications in the left breast for which disposition\nwould depend on the biopsy result for further follow-up.\n3. Predominantly anechoic cyst with septation in the left breast for which no\nadditional follow-up is needed.\n\nRECOMMENDATION(S):\n1. Ultrasound-guided biopsy of the dominant right breast mass.\n2. Follow-up for left breast would depend on the biopsy result of the right\nbreast.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\nThe patient is scheduled for biopsy at 15:00 on ___.\n\n The findings and recommendations left in the voicemail at ___, M.D.'s\noffice by ___, M.D. on the telephone on ___ at 5:10 pm, 10\nminutes after discovery of the findings.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 17:13 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "At the 4 o'clock position 3 cm from the nipple in the right breast there is a \ncircumscribed, complex cystic and solid mass measuring 3.5 x 1.7 x 3.6 cm\nwhich was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD, resident and ___, NP. The\nprocedure was supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 5 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nMammography was not performed as the patient experienced significant\ndiscomfort during the diagnostic evaluation and the HydroMARK clip was clearly\nvisible within the mass by ultrasound at the end of the procedure.", + "output": "Technically successful US-guided core biopsy of the right complex cystic and\nsolid mass at 4 o'clock. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted ultrasound of the left breast at 12 o'clock 1 cm from the nipple\ndemonstrates a 1.9 x 1.0 x 1.3 cm bilobed cyst corresponding to the palpable\nmass. Some minimal debris is noted in the smaller portion. This cyst is\nslightly larger compared to the prior ultrasound.", + "output": "1.9 cm left breast cyst.\n\nRECOMMENDATION(S): Clinical followup and/or aspiration for symptom relief.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a cluster of amorphous, probable benign microcalcifications in the\nleft upper outer breast spanning a 1.2 cm area. There are several grouped\nmicrocalcifications in the right central upper breast which ___ layering\non the true lateral views and remain stablethere is a well-circumscribed, 1 cm\nmass in the right central inferior breast for which ultrasound evaluation is\nperformed.\nThere is no other dominant mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. There is no significant change.\n\nRight breast ultrasound: Targeted ultrasound the right breast was performed. \nIn the right breast at ___ o'clock 3 cm from the nipple is a\nwell-circumscribed hypoechoic mass measuring 1 x 0.7 by 1 cm which shows\nposterior acoustic enhancement and some floating debris on real-time\nultrasound. This corresponds to the mass seen on mammography. Additionally a\ncyst with debris is noted in the right breast at 5 o'clock 3 cm from the\nnipple measuring 0.6 x 0.3 x 0.7 cm.", + "output": "1. Grouped microcalcifications in the left breast are likely benign. A\nsix-month follow-up mammogram is recommended to ensure stability.\n\n2. Mass in the right breast corresponds to a cyst with debris. \nBenign-appearing stable calcificationsin the right breast.\n\nRECOMMENDATION: Six-month follow-up left mammogram.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a cluster of amorphous, probable benign microcalcifications in the\nleft upper outer breast spanning a 1.2 cm area. There are several grouped\nmicrocalcifications in the right central upper breast which ___ layering\non the true lateral views and remain stablethere is a well-circumscribed, 1 cm\nmass in the right central inferior breast for which ultrasound evaluation is\nperformed.\nThere is no other dominant mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. There is no significant change.\n\nRight breast ultrasound: Targeted ultrasound the right breast was performed. \nIn the right breast at ___ o'clock 3 cm from the nipple is a\nwell-circumscribed hypoechoic mass measuring 1 x 0.7 by 1 cm which shows\nposterior acoustic enhancement and some floating debris on real-time\nultrasound. This corresponds to the mass seen on mammography. Additionally a\ncyst with debris is noted in the right breast at 5 o'clock 3 cm from the\nnipple measuring 0.6 x 0.3 x 0.7 cm.", + "output": "1. Grouped microcalcifications in the left breast are likely benign. A\nsix-month follow-up mammogram is recommended to ensure stability.\n\n2. Mass in the right breast corresponds to a cyst with debris. \nBenign-appearing stable calcificationsin the right breast.\n\nRECOMMENDATION: Six-month follow-up left mammogram.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 3 Probably Benign." + }, + { + "input": "50 cc of non purulent bilious fluid was aspirated.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Fluid sample was sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 60, 75, and 79 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 96 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 73, 79, and 70 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 76 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nSlight tardus et parvus waveforms bilaterally consistent with known AS.", + "output": "No atherosclerosis or hemodynamically significant stenosis in the bilateral\ncarotid arteries." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: There is a circumscribed mass in the slight lateral inferior\naspect of the breast measuring approximately 13 mm corresponding to the mass\nidentified on the recent CT. Otherwise there is no suspicious\nmicrocalcification, mass or distortion.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the right breast demonstrated\nan ovoid hypoechoic parallel mass with minimal internal vascularity at 8\no'clock 3 cm from nipple measuring 1.3 x 0.5 x 1.3 cm. Question of an\nadjacent tiny hypoechoic mass which I was not able to reproduce during my\nscanning. Follow-up is recommended given the the benign-appearing. However\nthe patient prefers and ultrasound-guided biopsy for definitive diagnosis\ngiven family history of breast and ovarian cancer.", + "output": "Left breast: No evidence of malignancy.\n\nRight breast: Corresponding to the CT finding there is a benign-appearing mass\nlikely fibroadenoma at 8 o'clock. Although follow-up was recommended the\npatient prefers definitive diagnosis at this time via an ultrasound-guided\nbiopsy.\n\nRECOMMENDATION(S): Right breast ultrasound-guided biopsy.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: There is a circumscribed mass in the slight lateral inferior\naspect of the breast measuring approximately 13 mm corresponding to the mass\nidentified on the recent CT. Otherwise there is no suspicious\nmicrocalcification, mass or distortion.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the right breast demonstrated\nan ovoid hypoechoic parallel mass with minimal internal vascularity at 8\no'clock 3 cm from nipple measuring 1.3 x 0.5 x 1.3 cm. Question of an\nadjacent tiny hypoechoic mass which I was not able to reproduce during my\nscanning. Follow-up is recommended given the the benign-appearing. However\nthe patient prefers and ultrasound-guided biopsy for definitive diagnosis\ngiven family history of breast and ovarian cancer.", + "output": "Left breast: No evidence of malignancy.\n\nRight breast: Corresponding to the CT finding there is a benign-appearing mass\nlikely fibroadenoma at 8 o'clock. Although follow-up was recommended the\npatient prefers definitive diagnosis at this time via an ultrasound-guided\nbiopsy.\n\nRECOMMENDATION(S): Right breast ultrasound-guided biopsy.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "There is a hypoechoic ovoid mass at 8 o'clock 3 cm from nipple similar to the\nexam of earlier today. This was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle and 14-gauge Bard spring-loaded biopsy\ndevicewere used to obtain 4 cores. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: Deferred.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Initial imaging through the anal canal at 5 mm intervals shows a internal and\nexternal sphincters to be intact and no obvious abscess or fluid collection\nseen. After cannulation of the fistula and injection of hydrogen peroxide,\nmicro bubbles were immediately seen extending from the left anterior perineum\n(1 o'clock) to the anal mucosa at 12 o'clock in the very distal anal canal. \nThe fistulous tract appears to be intersphincteric. The 3D volume side of the\nimages was manipulated and the fistula was measured at between 9-11 mm in\nlength.", + "output": "The study demonstrates the left anterior distal intersphincteric perianal\nfistula comment involving and no more than the distal ___ of the anal canal." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight: There is no discrete tumor mass seen by mammography surrounding the\nribbon clip in the right lateral breast at posterior depth. Diffuse scattered\npunctate calcifications are seen similar to the priors. There is no new\nsuspicious dominant mass.\n\nLeft: The left breast biopsied tumor mass is again seen in the inferior\ncentral-medial breast measuring 1.4 x 1.7 x 1.9 cm (TRV, AP, SAG). It appears\nsmaller by mammography compared to ___ when it measured 2.6 x 2.0\nx 2.9 cm. There is no new suspicious dominant mass or suspicious grouped\ncalcifications.\n\nBILATERAL BREAST ULTRASOUND:\nRight breast: At 9 o'clock 5 cm from the nipple there is a an irregular\nhypoechoic tumor mass measuring 4 x 4 x 5 mm with some prominent vascularity\nand no posterior shadowing.\nThe right breast mass previously measured 6 x 4 x 5 mm on ultrasound ___ and 8 x 8 x 6 mm ___ (by my measurements).\n\nLeft breast: At 7 o'clock 1-3 cm from the nipple there is an irregular\nheterogeneous hypoechoic tumor mass measuring 1.8 x 1.1 x 2.0 cm with dominant\nvascularity along 1 of the margins and some posterior shadowing. On today's\nimages the tumor appears to extend to within 1 cm of the base of the nipple.\n\nThe tumor appears larger in the AP dimension compared to the prior study of ___ when it measured 1.7 x 0.9 x 2.2 cm (by my measurements) and\nsmaller compared to 2.6 x 1.2 x 2.6 cm on imaging from ___ (by my\nmeasurements).", + "output": "Right: Persistent 5 mm tumor mass in the right breast at 9 o'clock.\n\nLeft: Tumor mass in the left breast at 7 o'clock measuring up to 2 cm,\nslightly larger in AP dimension on the current imaging, extending within 1 cm\nof the base of the nipple.\n\nRECOMMENDATION(S): Continued therapy per the patient and her breast cancer\ncare team.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight: There is no discrete tumor mass seen by mammography surrounding the\nribbon clip in the right lateral breast at posterior depth. Diffuse scattered\npunctate calcifications are seen similar to the priors. There is no new\nsuspicious dominant mass.\n\nLeft: The left breast biopsied tumor mass is again seen in the inferior\ncentral-medial breast measuring 1.4 x 1.7 x 1.9 cm (TRV, AP, SAG). It appears\nsmaller by mammography compared to ___ when it measured 2.6 x 2.0\nx 2.9 cm. There is no new suspicious dominant mass or suspicious grouped\ncalcifications.\n\nBILATERAL BREAST ULTRASOUND:\nRight breast: At 9 o'clock 5 cm from the nipple there is a an irregular\nhypoechoic tumor mass measuring 4 x 4 x 5 mm with some prominent vascularity\nand no posterior shadowing.\nThe right breast mass previously measured 6 x 4 x 5 mm on ultrasound ___ and 8 x 8 x 6 mm ___ (by my measurements).\n\nLeft breast: At 7 o'clock 1-3 cm from the nipple there is an irregular\nheterogeneous hypoechoic tumor mass measuring 1.8 x 1.1 x 2.0 cm with dominant\nvascularity along 1 of the margins and some posterior shadowing. On today's\nimages the tumor appears to extend to within 1 cm of the base of the nipple.\n\nThe tumor appears larger in the AP dimension compared to the prior study of ___ when it measured 1.7 x 0.9 x 2.2 cm (by my measurements) and\nsmaller compared to 2.6 x 1.2 x 2.6 cm on imaging from ___ (by my\nmeasurements).", + "output": "Right: Persistent 5 mm tumor mass in the right breast at 9 o'clock.\n\nLeft: Tumor mass in the left breast at 7 o'clock measuring up to 2 cm,\nslightly larger in AP dimension on the current imaging, extending within 1 cm\nof the base of the nipple.\n\nRECOMMENDATION(S): Continued therapy per the patient and her breast cancer\ncare team.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Liver: The liver appears diffusely coarsened and nodular consistent with known\ncirrhosis. No focal liver lesions are identified. There is no ascites. There\nis stable splenomegaly, with the spleen measuring cm. There is no\nintrahepatic biliary dilation. The CHD measures 6 mm. There is no evidence of\nstones or gallbladder wall thickening. No ascites.\n\nDoppler:\nThe main portal vein is patent with hepatopetal flow.\nThe TIPS is patent and demonstrates wall-to-wall flow.\nPortal vein and intra-TIPS velocities are as follows:\nMain portal vein: 33.8 cm/sec\nProximal TIPS: 62.5 cm/sec\nMid TIPS: 183 cm/sec\nDistal TIPS: 118 cm/sec\n\nFlow within the left portal vein is towards the TIPS shunt. Flow within the\nright anterior portal vein is towards the TIPS. Appropriate flow is seen in\nthe hepatic veins and IVC.\n\nPANCREAS: The head and proximal body of the pancreas are within normal limits.\nThe tail of the pancreas is not visualized due to the presence of gas.\n\nKIDNEYS: Limited views of the kidneys demonstrate no hydronephrosis.\n\nSpleen: The spleen is enlarged measuring 15.7 cm in length.\n\nRETROPERITONEUM: Visualized portions of aorta and IVC are within normal\nlimits.", + "output": "Cirrhotic liver with patent TIPS. Splenomegaly.\nPlease refer to subsequent CT for further details regarding lesion in the\npancreatic uncinate process." + }, + { + "input": "SPLEEN: Normal echogenicity.\n Spleen length: 9.4 cm\n\nNo perisplenic ascites.", + "output": "Normal ultrasound of the spleen." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 7 mm reniform mass in the right axilla, corresponding to the area\nof axillary tenderness as indicated by the patient. There are no suspicious\ngrouped microcalcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right axilla in the area of\nconcern as indicated by the patient demonstrates multiple benign appearing\nlymph nodes, the largest of which measures up to 1.2 cm. No suspicious solid\nmass or cystic lesion is identified.", + "output": "Benign-appearing lymph nodes in the right axilla corresponding to the area of\nconcern as indicated by the patient and requisition. No specific mammographic\nevidence of malignancy. Any decision to biopsy at this time should be based\non the clinical assessment.\n\nRECOMMENDATION(S): Age and risk appropriate mammography. Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 90 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 62, 90, and 75 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 84 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 89 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 52, 7 8, and 92 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 70 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "NO EVIDENCE OF FILLING DEFECTS SEEN IN EITHER CAROTID BULB. NO SIGNIFICANT\nPLAQUE. NORMAL CAROTID VELOCITIES." + }, + { + "input": "Intraoperative ultrasound guidance was provided to Dr. ___\n___ of the liver, with screening for potential metastases.\nTwo adjacent lesions are demonstrated within the right hepatic lobe, adjacent\nto a known gallbladder mass, the larger lesion measuring 7 mm, located\napproximately 8 mm lateral to the mass, the second measuring 2 mm, located\nmore laterally at the inferior tip of the right hepatic lobe, both concerning\nfor metastases. A 9 mm echogenic lesion, also suspicious for metastasis, lies\nadjacent to the gallbladder mass.\n\nPlease see the operative notes for further details.", + "output": "Intraoperative ultrasound examination of the liver, with at least 3 lesions\ndetected, detailed above. Please see the operative note for further details." + }, + { + "input": "Hypoechoic mass in the left breast at 8 o'clock 7 cm from the nipple\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\n\nSpecimens: Sent to Pathology.\nAnesthesia: 1% lidocaine\nComplications: None\nPOST-PROCEDURE MAMMOGRAM: Cc lateral views all 4 of limited due to difficulty\npositioning the patient appear and the clip was not visualized.\nStandard post care instructions were provided to the patient.", + "output": "Successful ultrasound guided biopsy." + }, + { + "input": "The liver is normal in echotexture without focal lesions or intrahepatic\nbiliary duct dilatation. Main portal vein is patent with hepatopetal flow. \nThe CBD is not dilated, measuring 2 mm. The gallbladder is unremarkable,\nwithout evidence of stones or gallbladder wall thickening. The imaged portion\nof the pancreas appears within normal limits, without masses or pancreatic\nductal dilation, with portions of the pancreatic tail obscured by overlying\nbowel gas. The spleen measures 9.8 cm, and is normal in echogenicity.\n\nThe right kidney measures 10.9 cm. The left kidney measures 11.4 cm. Normal\ncortical echogenicity and corticomedullary differentiation is seen\nbilaterally. There is no evidence of masses, stones or hydronephrosis in the\nkidneys.\n\nThere is no evidence of ascites. The visualized portions of aorta and IVC are\nwithin normal limits.", + "output": "Normal abdominal ultrasound." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere is no mammographic lesion in the central inferior right breast to\ncorrespond to the 7 mm mass seen along the central inferior right breast on\naxial images from the chest CTA dated ___. MLO spot compression\nviews of the inferior right breast demonstrate a well-defined rounded density\nat posterior depth which measures approximately 1.1 cm, although incompletely\nimaged. When compared with coronal and sagittal images from the CTA, this is\nlike the same finding, as the lesion measures 1 cm in the sagittal plane on\nCTA.\n\nPreviously described global asymmetry in the upper-outer right breast is again\nseen and is stable. There are prominent axillary lymph nodes which are also\nstable since at least ___. No suspicious microcalcifications or\nunexplained architectural distortion is seen.\n\nTARGETED RIGHT BREAST ULTRASOUND: Targeted ultrasound examination of the right\nbreast was performed from the 5 o'clock to 8 o'clock position, 2-8 cm from the\nnipple. There is no ultrasound lesion in the central inferior right breast. \nAt the 8 o'clock position, 8 cm from the nipple, there is a 1.1 x 1.0 cm lymph\nnode with echogenic hilum that is somewhat eccentric with prominent cortex at\nthe poles, which correlates with the 1.1 cm mammographic findings seen in the\ninferior right breast. Known right axillary adenopathy with cortical\nthickening is again seen, with the largest lymph node measuring up to 1.6 cm\nand cortex to 5 mm.", + "output": "1.1 cm right intramammary lymph node with prominent cortex, which likely\ncorrelates to the CTA finding as seen on the coronal and sagittal imgaes. \nUpon comparison with prior abdominal/pelvic CT dated ___, this lesion\ndemonstrates stability in the axial plane as well.\n\nChronic axillary adenopathy due to the patient's illness.\n\nRECOMMENDATION: As the patient has known reactive follicular hyperplasia and\nprogressive transformation of germinal centers with known stable prominent\naxillay lymph nodes, and this finding is stable, routine screening mammography\nis recommended.\n\nNOTIFICATION: Findings were discussed with the patient upon completion of\nexamination.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of\n90/21 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n61/15 cm/sec in its proximal portion, 47/13 cm/sec in its mid portion and\n65/16 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 40cm/sec.\nThe vertebral artery has peak systolic velocity of 34 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 0.72.\n\nLEFT:\nNote is made of a carotid artery stent on the left. Mild intimal thickening\nis noted.\nThe left common carotid artery had peak systolic/diastolic velocities of 58/16\ncm/sec.\nThe left internal carotid artery had peak systolic/diastolic velocities of\n39/8 cm/sec in its proximal portion, 157/41 cm/sec in its mid portion and\n136/34 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 120cm/sec.\nThe vertebral artery has peak systolic velocity of 45 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 2.7.", + "output": "1. Mild heterogeneous plaque burden on the right. Less than 40% stenosis of\nthe right internal carotid artery.\n2. Prior carotid stent placement. 60-69% stenosis of the left internal\ncarotid artery." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. There are postsurgical changes in the\nupper outer middle depth. There is a marker clip just superior to the\nsurgical bed.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted sonography of the left breast was performed\nat 4 o'clock. In addition ___ o'clock regions were scanned. No cystic, solid\nor shadowing findings are noted.", + "output": "No mammographic evidence of malignancy.\n\nNo sonographic abnormality in the area of symptomatology in the left breast.\n\nRECOMMENDATION(S): Continued clinical follow-up is recommended. Assuming\nthere is no change the patient can resume annual screening mammography\nschedule.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. There are postsurgical changes in the\nupper outer middle depth. There is a marker clip just superior to the\nsurgical bed.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted sonography of the left breast was performed\nat 4 o'clock. In addition ___ o'clock regions were scanned. No cystic, solid\nor shadowing findings are noted.", + "output": "No mammographic evidence of malignancy.\n\nNo sonographic abnormality in the area of symptomatology in the left breast.\n\nRECOMMENDATION(S): Continued clinical follow-up is recommended. Assuming\nthere is no change the patient can resume annual screening mammography\nschedule.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: Bilateral subglandular implants are present. The overlying\nparenchyma is predominantly fatty. There is no dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nLEFT BREAST ULTRASOUND:\n\nThe left upper inner quadrant, at the site of clinical concern was scanned . \nThere is no cystic or solid mass. There is an implant for this corresponds to\nthe area of palpable concern.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION: Age and risk appropriate screening.\n\nNOTIFICATION: Findings were discussed with the patient.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "The aorta measures 1.9 cm in the proximal portion, 2.2 cm in mid portion and\n1.7 cm in the distal abdominal aorta. There is moderate calcified\natherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.8 cm and the left common iliac artery\nmeasures 1.0 cm.\n\nThe right kidney measures 12.8 cm and the left kidney measures 12.3 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "No evidence of abdominal aortic aneurysm. Moderate amount of calcified\natherosclerotic plaque throughout the abdominal aorta." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 20 cc of clear, straw-colored fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically-successful ultrasound-guided diagnostic paracentesis yielding 10\ncc of clear, straw-colored fluid. Fluid samples were submitted to the\nlaboratory." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 20\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Intraoperative ultrasound guidance was provided to Dr. ___ Dr. ___\n___ demarcation of the pancreas.\n\nA full assessment of the pancreas revealed a markedly heterogeneous parenchyma\nwith numerous punctate calcifications, denoting chronic pancreatitis. The\npancreatic duct was moderately dilated at the body and tail, with narrowing\nthrough the head. Anterior to the pancreas is a large pseudocyst, better\nvisualized on the CT examination from ___. A CBD stent lies\nlaterally.\n\nCareful assessment of the pancreas was performed. No concerning solid mass\nwas detected. Ultrasound was then used to guide initial cannulation of the\nmain pancreatic duct. Following further dissection, ultrasound was again used\nto confirm access of the duct within the pancreatic head and communication\nwith the anterior pseudocyst, which was drained.\n\nPlease see the operative notes for further details.", + "output": "Intraoperative ultrasound examination of pancreas, demonstrating chronic\npancreatitis and an anterior pseudocyst, without focal mass. Please see the\noperative note for further details." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 121 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 78, 89, and 92 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 0.76.\nThe external carotid artery has peak systolic velocity of 128 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild calcified atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 113 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 105, 87, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 0.92.\nThe external carotid artery has peak systolic velocity of 110 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "<40% stenosis of the bilateral ICAs, similar to ___." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 54, 105, and 82 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 80 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 78 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 60, 99, and 96 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Essentially normal carotid ultrasound. No hemodynamically significant\nstenoses noted on either side (less than 40%).\n\nAntegrade flow both vertebral arteries." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\nThere is no dominant mass, suspicious cluster of calcifications or\narchitectural distortion. Vascular calcifications are noted. No significant\ninterval change.\n\nRIGHT BREAST ULTRASOUND: Right breast ultrasound was performed at 8 o'clock\n0-7 cm from the nipple in the area of clinical concern. There is no mass\nidentified. No concerning findings.", + "output": "No evidence of malignancy. Final disposition of the palpable area should be\nbased on clinical evaluation.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\nThere is no dominant mass, suspicious cluster of calcifications or\narchitectural distortion. Vascular calcifications are noted. No significant\ninterval change.\n\nRIGHT BREAST ULTRASOUND: Right breast ultrasound was performed at 8 o'clock\n0-7 cm from the nipple in the area of clinical concern. There is no mass\nidentified. No concerning findings.", + "output": "No evidence of malignancy. Final disposition of the palpable area should be\nbased on clinical evaluation.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 8\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nMixed soft and hard plaque is seen in the right carotid bulb and at the origin\nof the right ICA.\nThe peak systolic velocity in the right common carotid artery is 67 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 86, 152, and 128 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 47 cm/sec.\nThe ICA/CCA ratio is 2.28.\nThe external carotid artery has peak systolic velocity of 150 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nMixed soft and hard plaque is seen in the distal left common carotid artery\nand in the left carotid bulb.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 189, 215, and 187 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 74 cm/sec.\nThe ICA/CCA ratio is 2.93.\nThe external carotid artery has peak systolic velocity of 233 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate stenosis (40-59%) in the right internal carotid artery.\n2. Moderately severe stenosis (60-69%) in the left internal carotid artery." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThere are scattered areas of fibroglandular density. There is an 8 mm\ncircumscribed nodule in the medial lower posterior right breast. This likely\nrepresents a benign entity, however, further evaluation with ultrasound was\nperformed. No suspicious microcalcifications or unexplained architectural\ndistortion is seen in either breast. As the patient's breast pain is diffuse\nand bilateral, no dedicated ultrasound was performed to evaluate this.\n\nRIGHT BREAST ULTRASOUND:\n\nThe lower right inner breast was scanned and no abnormality was identified. \nThe questioned abnormality at 4 o'clock 4-5 cm from the nipple has the\nappearance of a benign fat lobule on real-time scanning.", + "output": "8 mm nodule in the lower inner right breast likely is a benign entity.\n\nRECOMMENDATION: Six-month followup right breast mammogram is recommended.\nFurther management for the areas of clinical concern in both breasts should be\nbased on the clinical assessment.\n\nNOTIFICATION: This was discussed with the patient at the time the exam.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThere are scattered areas of fibroglandular density. There is an 8 mm\ncircumscribed nodule in the medial lower posterior right breast. This likely\nrepresents a benign entity, however, further evaluation with ultrasound was\nperformed. No suspicious microcalcifications or unexplained architectural\ndistortion is seen in either breast. As the patient's breast pain is diffuse\nand bilateral, no dedicated ultrasound was performed to evaluate this.\n\nRIGHT BREAST ULTRASOUND:\n\nThe lower right inner breast was scanned and no abnormality was identified. \nThe questioned abnormality at 4 o'clock 4-5 cm from the nipple has the\nappearance of a benign fat lobule on real-time scanning.", + "output": "8 mm nodule in the lower inner right breast likely is a benign entity.\n\nRECOMMENDATION: Six-month followup right breast mammogram is recommended.\nFurther management for the areas of clinical concern in both breasts should be\nbased on the clinical assessment.\n\nNOTIFICATION: This was discussed with the patient at the time the exam.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. No suspicious abnormalities are noted in the vicinity of\nthe palpable marker.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in all the areas of the\nreported breast pain including upper inner, subareolar and lower outer left\nbreast which was without any discrete suspicious solid or cystic masses.", + "output": "No suspicious mammographic or sonographic findings in the areas of focal pain.\n\nRECOMMENDATION(S): Clinical followup for breast pain is recommended. Final\npatient disposition should be based on clinical assessment. The patient will\nbe due for annual bilateral screening mammogram in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. No suspicious abnormalities are noted in the vicinity of\nthe palpable marker.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in all the areas of the\nreported breast pain including upper inner, subareolar and lower outer left\nbreast which was without any discrete suspicious solid or cystic masses.", + "output": "No suspicious mammographic or sonographic findings in the areas of focal pain.\n\nRECOMMENDATION(S): Clinical followup for breast pain is recommended. Final\npatient disposition should be based on clinical assessment. The patient will\nbe due for annual bilateral screening mammogram in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal atherosclerotic plaque in the right\nexternal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 54 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 50, 53, and 48 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 77 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 52 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 32, 41, and 41 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 14 cm/sec.\nThe ICA/CCA ratio is 0.79.\nThe external carotid artery has peak systolic velocity of 63 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Normal bilateral internal carotid arteries. Minimal heterogeneous plaque at\nthe right external carotid artery origin." + }, + { + "input": "Scrotal ultrasound:\nThe right testicle measures: 2.7 x 2.3 x 4.0 cm.\nThe left testicle measures: 3.0 x 2.3 x 3.7 cm.\n\nThere is a simple cyst in the right testicle measuring up to 0.3 cm. \nTesticular echogenicity is otherwise normal, without focal abnormalities.\n\nThe epididymides are normal bilaterally. There is a simple cyst in the right\nepididymis measuring 0.6 x 0.6 x 0.8 cm.\n\nVascularity is normal and symmetric in the testes and epididymides.\n\nIn the right inferior pelvis, in the region of the visible wound, there is a\nlarge hematoma. The superior aspect of the hematoma measures approximately\n4.0 x 2.9 x 4.3 cm, and extends inferiorly along the right lateral aspect of\nthe right scrotal sac. Additionally, there is a focus of vascularity within\nthis hematoma (image 49), which may correspond to the area of active\nextravasation seen on the prior CT performed at ___.\n\nPenile ultrasound:\nEvaluation of the penis is slightly limited due to anatomy. Corpora cavernosa\nand tunic albuginea appear intact. Arterial flow was not definitely\nidentified within the cavernosal or dorsal penile arteries, but evaluation was\nlimited.", + "output": "1. Large right inferior pelvic hematoma measuring greater than 4 cm, which\nextends inferiorly along the right lateral aspect of the right scrotal sac. \nFlow within the hematoma likely corresponds to the focus of active\nextravasation seen on the prior CT.\n2. Normal testicular echogenicity and vascularity bilaterally.\n3. No evidence of ___ albuginea disruption to suggest penile fracture, on\nthis limited exam. If there is persistent clinical concern, a penile MRI can\nbe obtained for further evaluation.\n\nRECOMMENDATION(S): If there is high concern for penile fracture, MRI can be\nobtained for further assessment." + }, + { + "input": "Scrotal ultrasound:\nThe right testicle measures: 2.7 x 2.3 x 4.0 cm.\nThe left testicle measures: 3.0 x 2.3 x 3.7 cm.\n\nThere is a simple cyst in the right testicle measuring up to 0.3 cm. \nTesticular echogenicity is otherwise normal, without focal abnormalities.\n\nThe epididymides are normal bilaterally. There is a simple cyst in the right\nepididymis measuring 0.6 x 0.6 x 0.8 cm.\n\nVascularity is normal and symmetric in the testes and epididymides.\n\nIn the right inferior pelvis, in the region of the visible wound, there is a\nlarge hematoma. The superior aspect of the hematoma measures approximately\n4.0 x 2.9 x 4.3 cm, and extends inferiorly along the right lateral aspect of\nthe right scrotal sac. Additionally, there is a focus of vascularity within\nthis hematoma (image 49), which may correspond to the area of active\nextravasation seen on the prior CT performed at ___.\n\nPenile ultrasound:\nEvaluation of the penis is slightly limited due to anatomy. Corpora cavernosa\nand tunic albuginea appear intact. Arterial flow was not definitely\nidentified within the cavernosal or dorsal penile arteries, but evaluation was\nlimited.", + "output": "1. Large right inferior pelvic hematoma measuring greater than 4 cm, which\nextends inferiorly along the right lateral aspect of the right scrotal sac. \nFlow within the hematoma likely corresponds to the focus of active\nextravasation seen on the prior CT.\n2. Normal testicular echogenicity and vascularity bilaterally.\n3. No evidence of ___ albuginea disruption to suggest penile fracture, on\nthis limited exam. If there is persistent clinical concern, a penile MRI can\nbe obtained for further evaluation.\n\nRECOMMENDATION(S): If there is high concern for penile fracture, MRI can be\nobtained for further assessment." + }, + { + "input": "Evaluation of the proximal long head of the biceps tendon in the bicipital\ngroove reveals no normal appearing tendon in the proximal groove (image 2, 16,\n17). Disorganized and thickened tendon is seen in the distal portion of the\nbiceps groove (image 8). The distal biceps tendon is intact to the radial\ntuberosity (image 35).\n\nDue to patient pain and limited mobility only limited evaluation of the right\nshoulder could be obtained. The subscapularis tendon is grossly intact. \nThere is trace fluid in subacromial subdeltoid bursa (image 23).", + "output": "No normal appearing tendon is seen in the bicipital groove and there is\nthickened disorganized appearing tendon in the distal groove compatible with\ncomplete or high-grade biceps tendon tear." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the right breast\nperiareolar and subareolar areas of clinical concern as directed by the\npatient, which was without any discrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy in either breast. No\nsuspicious sonographic abnormality in the right breast areas of clinical\nconcern. Any decision for further intervention should be guided by the\nclinical assessment.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the right breast\nperiareolar and subareolar areas of clinical concern as directed by the\npatient, which was without any discrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy in either breast. No\nsuspicious sonographic abnormality in the right breast areas of clinical\nconcern. Any decision for further intervention should be guided by the\nclinical assessment.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 101 cm/s / 14.3 cm/s\nCCA Distal: 74.6 cm/s / 17 cm/s\nICA ___: 99.1 cm/s / 24.3 cm/s\nICA Mid: 120 cm/s / 32.8 cm/s\nICA Distal: 111 cm/s / 29 cm/s\nECA: 267 cm/s\nVertebral: 58.4 cm/s\n\nICA/CCA Ratio: 1.61\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 88.1 cm/s / 22.3 cm/s\nCCA Distal: 87.3 cm/s / 16.3 cm/s\nICA ___: 137 cm/s / 33.1 cm/s\nICA Mid: 134 cm/s / 28.6 cm/s\nICA Distal: 104 cm/s / 29.7 cm/s\nECA: 129 cm/s\nVertebral: 39 cm/s\n\nICA/CCA Ratio: 1.57\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 40-59% stenosis.\nLeft ICA 40-59% stenosis." + }, + { + "input": "The liver shows no evidence of focal lesions or textural abnormality. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The common\nbile duct measures 3 mm. The portal vein is patent. The gallbladder contains\nmultiple gallstones, the largest identified measures up to 12 mm. There is no\npericholecystic fluid. Visualized portions of the pancreatic head, neck and\nbody are normal without evidence of focal lesions or pancreatic duct\ndilatation. The spleen measures 9.1 cm and has homogenous echotexture. \nRepresentative images of the right and left kidneys are normal. The right\nkidney measures 11.4 cm and left kidney measures 11.1 cm. Visualized portions\nof the aorta and IVC are normal. There is no ascites.", + "output": "Multiple gallstones. No evidence of acute cholecystitis." + }, + { + "input": "Transverse and sagittal images were obtained of the superficial tissues of the\nleft abdominal wall in the region of the GJ tube site. The tube and bulb are\nvisualized. There is no fluid collection in the surrounding soft tissues..", + "output": "No collection around the GJ tube site in the left abdominal wall." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 120 cm/s / 20.3 cm/s\nCCA Distal: 86.9 cm/s / 19 cm/s\nICA ___: 57.1 cm/s / 13.2 cm/s\nICA Mid: 53.7 cm/s / 17.8 cm/s\nICA Distal: 55.2 cm/s / 17.6 cm/s\nECA: 70.5 cm/s\nVertebral: 58.7 cm/s\n\nICA/CCA Ratio: 0.66\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 99.6 cm/s / 13.8 cm/s\nCCA Distal: 81.3 cm/s / 16.8 cm/s\nICA ___: 44.2 cm/s / 14.4 cm/s\nICA Mid: 56.4 cm/s / 18 cm/s\nICA Distal: 60.4 cm/s / 17.6 cm/s\nECA: 56 cm/s\nVertebral: 80.8 cm/s\n\nICA/CCA Ratio: 0.74\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "4 quadrant ultrasound was obtained to evaluate for fluid volume check. Trace\nfree fluid was seen in the left upper quadrant.\n\nNo other findings on this limited ultrasound exam.", + "output": "Trace free fluid is seen in the left upper quadrant.\n\n The findings were discussed by Dr. ___ with Dr. ___ on the telephone on\n___ at 9:18 AM, 5 minutes after discovery of the findings. Paracentesis\nwill be declined at this time." + }, + { + "input": "Successful pigtail catheter placement with approximately 5 cc serosanguineous\nfluid drained from anterior abdominal wall collection. Sample was sent for\nmicrobiology. There are no immediate postprocedural complications.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation." + }, + { + "input": "There is re- demonstration of a 4.4 x 1.9 x 5.1 cm hypoechoic mass along the\nanterior abdominal wall, just deep to the rectus abdominis muscles. Mild\ninternal vascularity is seen on Doppler interrogation. A hypoechoic tract is\nseen connecting the mass to the dome of the bladder (image 22), suggestive of\na urachal remnant.", + "output": "Technically successful biopsy of an anterior abdominal lesion, which appears\nto be connected to the bladder by an urachal remnant. Samples were submitted\nfor pathology and microbiology (as the differential diagnosis includes an\ninflammatory process associated with urachal cyst, versus solid urachal\nassociated mass)." + }, + { + "input": "RIGHT:\nThere is moderate heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 73 cm/s / 5 cm/s\nCCA Distal: 92 cm/s / 4 cm/s\nICA ___: 96 cm/s / 16.2 cm/s,18.4 cm/s\nICA Mid: 141 cm/s / 16 cm/s\nICA Distal: 124 cm/s / 19.4 cm/s\nECA: 89 cm/s\nVertebral: 85 cm/s\n\nICA/CCA Ratio: 1.5\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is severe heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 107 cm/s / 14 cm/s\nCCA Distal: 102 cm/s / 20 cm/s\nICA ___: 103 cm/s / 18 cm/s\nICA Mid: 192 cm/s / 26 cm/s\nICA Distal: 118 cm/s / 23 cm/s with delayed upstroke\nECA: 84 cm/s\nVertebral: 60 cm/s\n\nICA/CCA Ratio: 1.8\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 40-59% stenosis.\nLeft ICA 60-69% stenosis in the mid ICA, though may be underestimated as poor\nimage quality due to significant shadowing from calcification with tardus\nparvus waveforms distal to the mid ICA suggesting a more significant stenosis.\n\nRECOMMENDATION(S): Consider cross-sectional imaging if clinically indicated." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate to severe heterogeneous\natherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 90 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 250, 253, and 148 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 2.8.\nThe external carotid artery has peak systolic velocity of 121 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate to severe heterogeneous\natherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 125 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 415, 287, and 117 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 88 cm/sec.\nThe ICA/CCA ratio is 3.3.\nThe external carotid artery has peak systolic velocity of 118 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Severe bilateral calcified plaque limits examination. With this in mind,\nthere is at least 70-79% stenosis in the right and at least 70-79% stenosis of\nthe left internal carotid arteries." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the hepatic hilum. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen from a subxiphoid approach. The site was marked. The skin\nwas then prepped and draped in the usual sterile fashion. The superficial soft\ntissues to the liver capsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a single 18-gauge core biopsy sample was\nobtained. The sample was provided to the on-site cytologist who indicated an\nadequate sample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 20\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 1, with specimen provided to\nthe cytologist." + }, + { + "input": "1. 12.7 cm right upper quadrant perihepatic collection near the liver dome.\n\n2. Thickened echogenic perihepatic fat likely from bile irritation, more\nprominent.\n\n3. Appropriate er catheter positioning with decompression of the collection\npost drainage.", + "output": "Drainage of right perihepatic dome collection yielding 250 cc yellow non-foul\nbilioenteric, purulent fluid." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic dome. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a single 18-gauge core biopsy sample was\nobtained. The sample was provided to the on-site cytologist who indicated an\nadequate sample. The sample was placed in formalin for Foundation One\ntesting.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 23\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 1, with specimen provided to\nthe cytologist." + }, + { + "input": "RIGHT:\n\nThere is a small amount of calcified atheromatous plaque at the right carotid\nbulb.\n\nThe right common carotid artery has a peak systolic velocity of 90 cm/sec.\n\nThe right internal carotid artery has peak systolic velocities of 113 cm/sec\nin its proximal portion, 87 cm/sec in its mid portion and 79 cm/sec in its\ndistal portion.\n\nPeak end diastolic velocity in the right internal carotid artery is 35 cm/sec.\n\nThe external carotid artery has peak systolic velocity of 79cm/sec.\n\nThe vertebral artery has peak systolic velocity of 76 cm/sec with normal\nantegrade flow.\n\nThe right ICA/CCA ratio is 1.6.\n\nLEFT:\n\nSimilar to the right side, there is a small amount of calcified atheromatous\nplaque at the left carotid bulb.\n\nThe left common carotid artery has a peak systolic velocity of 85 cm/sec.\n\nThe left internal carotid artery had peak systolic velocities of 90 cm/sec in\nits proximal portion, 77 cm/sec in its mid portion and 96 cm/sec in its distal\nportion.\n\nPeak end diastolic velocity in the right internal carotid artery is 30 cm/sec.\n\nThe external carotid artery has peak systolic velocity of 112cm/sec.\n\nThe vertebral artery has peak systolic velocity of 48 cm/sec with normal\nantegrade flow.\n\nThe left ICA/CCA ratio is 1.1.", + "output": "Mild (___) carotid stenosis of the proximal right internal carotid artery. \nNo hemodynamically significant stenosis on the left." + }, + { + "input": "Solid mass in the right omentum seen, this was targeted for biopsy.", + "output": "Ultrasound guided biopsy of the right solid omental mass." + }, + { + "input": "Limited grayscale and color ultrasound of the abdomen demonstrated a large,\nanechoic collection with septations in the left lower quadrant. This was\ntargeted for ultrasound-guided drainage.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the collection in the lower quadrant and\n400 cc of clear yellow fluid were removed. Fluid samples were submitted to the\nlaboratory for cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided drainage of a left lower quadrant\nfluid collection. 400 mL of clear serous fluid removed. A drainage catheter\nwas not left in place as per prior discussion with the attending taking care\nof the patient. Samples were sent to the laboratory for cytology." + }, + { + "input": "In the left lower abdomen, a fluid collection was demonstrated, which closely\nabutted the abdominal wall. This was targeted for ultrasound-guided catheter\ndrainage.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nFocal asymmetry is seen in the upper, central left breast at posterior depth,\nwhich persists on spot compression and rolled views. This was further\nevaluated ultrasound. There is no suspicious microcalcifications or\nunexplained architectural distortion.\n\nBREAST ULTRASOUND:\n\nLEFT BREAST: At 1 o'clock, 7 cm from nipple there is a 0.6 x 0.3 x 0.5 cm\noval, circumscribed, anechoic mass with increased through transmission and no\ninternal vascularity, consistent with a simple cyst. This likely does not\ncorrespond to the focal asymmetry seen on mammography. No sonographic\nfindings were seen to correspond to the asymmetry.\n\nRIGHT BREAST: At 10 o'clock, 11 cm from the nipple there is a 2.7 x 1.8 x 2.4\ncm irregular bilobed heterogeneous mass with irregular margins, increased\nthrough transmission, and internal vascularity. Previously, this mass\nmeasured 1.8 x 1.2 x 0.9 cm in ___.\n\nThe right axilla was scanned. Multiple (at least 5) abnormal appearing lymph\nnodes are present, the largest of which measures 3.3 x 2.2 x 3.1 cm. \nPreviously this lymph node measured 3.1 x 1.8 x 3.2 cm in ___.", + "output": "1. The suspicious right breast mass at 10 o'clock, 11 cm from the nipple has\nincreased in size over the interval. Ultrasound-guided biopsy of this mass is\nscheduled for the same day as this diagnostic workup.\n2. Multiple abnormal, enlarged right axillary lymph nodes with the largest 1\nmeasuring 3.3 cm. Ultrasound-guided FNA of the dominant lymph node is\nscheduled for the same day as this diagnostic work-up.\n3. Focal asymmetry in the upper outer left breast is likely benign, however\nwill be further evaluated with the recommended breast MRI.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of right breast mass and of\nthe dominant right axillary lymph node.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nAdditionally, findings and recommendations were communicated by emailed to\n___, NP by Dr. ___ on ___. Breast MRI is\nrecommended for extent of disease.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Right breast mass at 10 o'clock 11 cm from the nipple with internal\nvascularity measures 2.4 x 1.8 x 1.5 cm which is targeted for\nultrasound-guided core needle biopsy. Additionally, in the right axilla,\nthere is a 3.6 x 3 x 2.3 cm hypoechoic mass with internal vascularity that\nrepresents an abnormal lymph node which is targeted for sound guided fine\nneedle aspiration.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nNext, attention was turned to the right axillary lymph node. Using ultrasound\nguidance, aseptic technique and local anesthesia, a two 25 gauge and one 22\ngauge needle was advanced into the lesion and aspirated. Next, a percutaneous\nHydroMark coil was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement of the ribbon clip in the right breast mass. The right axillary\nmass and clip was not visualized on post procedure mammogram, however, was\nvisualized to be within the right axilla lymph node on real-time and static\nultrasound imaging.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nTechnically successful ultrasound-guided final aspiration of right axillary\nlymph node. Pathology and cytology are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Right breast mass at 10 o'clock 11 cm from the nipple with internal\nvascularity measures 2.4 x 1.8 x 1.5 cm which is targeted for\nultrasound-guided core needle biopsy. Additionally, in the right axilla,\nthere is a 3.6 x 3 x 2.3 cm hypoechoic mass with internal vascularity that\nrepresents an abnormal lymph node which is targeted for sound guided fine\nneedle aspiration.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nNext, attention was turned to the right axillary lymph node. Using ultrasound\nguidance, aseptic technique and local anesthesia, a two 25 gauge and one 22\ngauge needle was advanced into the lesion and aspirated. Next, a percutaneous\nHydroMark coil was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement of the ribbon clip in the right breast mass. The right axillary\nmass and clip was not visualized on post procedure mammogram, however, was\nvisualized to be within the right axilla lymph node on real-time and static\nultrasound imaging.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nTechnically successful ultrasound-guided final aspiration of right axillary\nlymph node. Pathology and cytology are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nFocal asymmetry is seen in the upper, central left breast at posterior depth,\nwhich persists on spot compression and rolled views. This was further\nevaluated ultrasound. There is no suspicious microcalcifications or\nunexplained architectural distortion.\n\nBREAST ULTRASOUND:\n\nLEFT BREAST: At 1 o'clock, 7 cm from nipple there is a 0.6 x 0.3 x 0.5 cm\noval, circumscribed, anechoic mass with increased through transmission and no\ninternal vascularity, consistent with a simple cyst. This likely does not\ncorrespond to the focal asymmetry seen on mammography. No sonographic\nfindings were seen to correspond to the asymmetry.\n\nRIGHT BREAST: At 10 o'clock, 11 cm from the nipple there is a 2.7 x 1.8 x 2.4\ncm irregular bilobed heterogeneous mass with irregular margins, increased\nthrough transmission, and internal vascularity. Previously, this mass\nmeasured 1.8 x 1.2 x 0.9 cm in ___.\n\nThe right axilla was scanned. Multiple (at least 5) abnormal appearing lymph\nnodes are present, the largest of which measures 3.3 x 2.2 x 3.1 cm. \nPreviously this lymph node measured 3.1 x 1.8 x 3.2 cm in ___.", + "output": "1. The suspicious right breast mass at 10 o'clock, 11 cm from the nipple has\nincreased in size over the interval. Ultrasound-guided biopsy of this mass is\nscheduled for the same day as this diagnostic workup.\n2. Multiple abnormal, enlarged right axillary lymph nodes with the largest 1\nmeasuring 3.3 cm. Ultrasound-guided FNA of the dominant lymph node is\nscheduled for the same day as this diagnostic work-up.\n3. Focal asymmetry in the upper outer left breast is likely benign, however\nwill be further evaluated with the recommended breast MRI.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of right breast mass and of\nthe dominant right axillary lymph node.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nAdditionally, findings and recommendations were communicated by emailed to\n___, NP by Dr. ___ on ___. Breast MRI is\nrecommended for extent of disease.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "In the left breast 2 o'clock 15 cm from the nipple, there is an abnormal lymph\nnode with eccentric cortical thickening measuring 0.6 cm. The lymph node in\ntotal measures 1.4 x 1.3 x 0.6 cm. This corresponds to the abnormal appearing\nlow left axillary lymph node seen on the comparison MRI from ___\n(7:68). This is recommended for ultrasound-guided tissue sampling.\n\nIn the left breast 3 o'clock 14 cm from the nipple, there is a normal\nappearing lymph node without cortical thickening that measures 0.7 x 0.7 x 0.4\ncm and corresponds to the lateral left inframammary fold lymph node seen on\nthe comparison MRI (7:26).", + "output": "1. Abnormal left axillary lymph node with eccentric cortical thickening which\ncorresponds to the abnormal lymph node seen on the comparison MRI for which\ntissue sampling is recommended.\n2. There is a sonographically normal appearing lymph node in the lateral left\ninframammary fold.\n\nRECOMMENDATION(S): Immediate ultrasound-guided needle biopsy of left axillary\nlymph node.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan.\n\nBI-RADS: 4B Suspicious - moderate suspicion for malignancy." + }, + { + "input": "In the left breast 2 o'clock 15 cm from the nipple, there is an abnormal low\naxillary lymph node with cortical thickening measuring 0.6 cm. This is\ntargeted for core needle biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD ___, M.D.. The procedure was supervised by\n___, M.D. (attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. Appropriate position within the lymph node was confirmed on\nreal-time imaging. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: Defered due to axillary and posterior position of\nthe lymph node. Appropriate position within the biopsied lymph node was\nconfirmed on real-time imaging.", + "output": "Technically successful US-guided core biopsy of the left axillary lymph node. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "BREAST ULTRASOUND: Targeted ultrasound was performed of the bilateral\npalpable abnormalities.\n\nRight breast:\n\nAt the 9 o'clock position 11 cm from the nipple corresponding to 1 of the\npalpable abnormalities of concern, there is an approximately 1.2 x 0.9 x 1.2\ncm oval, circumscribed, hypoechoic mass with a thin hyperechoic rim and no\ninternal vascularity. This mass is in the area of the patient's lumpectomy\nscar.\n\nAt the 9 to 10:00 position of the right breast approximately 9 cm from the\nnipple, there is a 3.5 x 1.5 x 1.5 cm oval, circumscribed, isodense hypoechoic\nmass with little internal vascularity corresponding to an additional palpable\nabnormality of concern.\n\nLeft breast:\n\nAt the 11 o'clock position of the left breast approximately 2 cm from the\nnipple, there is an approximately 1.5 x 1.2 x 1.5 cm round, predominantly\nhyperechoic, heterogeneous mass with no internal vascularity corresponding to\none of the patient's palpable abnormalities of concern.\n\nAt the 1 o'clock position of the left breast approximately 3-4 cm from the\nnipple, no abnormal solid or cystic lesion is identified to correspond to one\nof the patient's palpable abnormalities of concern.\n\nAt the 5 o'clock position of the left breast approximately 5-6 cm from the\nnipple there is a 1.7 x 1.1 x 1.7 cm round, partially circumscribed partially\nindistinct heterogeneous mass with suggestion of a hyperechoic rim\ncorresponding to an additional palpable abnormality of concern.\n\nBB markers were then placed over the patient's palpable abnormalities of\nconcern within the bilateral breasts and mammography was obtained including\nspot tangent views.\n\n\nTissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\n\nRight breast:\n2 BB markers are visualized overlying the palpable abnormalities of concern in\nthe upper outer right breast in the region of the lumpectomy bed. The masses\nat the 9 o'clock position 11 cm from the nipple and the 9 to 10:00 position\napproximately 9 cm from the nipple on ultrasound correspond to areas of fat\nnecrosis as confirmed on the mammogram. Also noted are postsurgical changes\nwithin this area including surgical clips.\n\nLeft breast:\n2 BB markers are visualized overlying the palpable abnormalities of concern\nwithin the lower central left breast and upper inner left breast. The mass at\nthe 11 o'clock position of the left breast approximately 2 cm on ultrasound\ncorresponds to an area of fat necrosis on mammography. No suspicious\nabnormality is visualized at the 1 o'clock position 3-4 cm from the nipple. \nThe mass at the 5 o'clock position of the left breast approximately 5 cm from\nthe nipple on the ultrasound corresponds to an asymmetry visualized within the\ninferior left breast on the MLO view without definite correlate on the CC\nview. This is probably benign and likely represents fat necrosis.", + "output": "1. 1.7 x 1.1 x 1.7 cm probably benign mass at the 5 o'clock position of the\nleft breast 5-6 cm from the nipple. This likely represents fat necrosis. \nHowever, diagnostic left breast ultrasound is recommended in 6 months to\nensure stability.\n2. Palpable abnormalities at the 9 o'clock and 9 to 10:00 position of the\nright breast, as described above, correspond to areas of fat necrosis as\nconfirmed on mammography.\n3. Palpable abnormality at the 11 o'clock position of the left breast\napproximately 2 cm from the nipple, as described above, corresponds to an area\nof fat necrosis as confirmed on mammography.\n4. No mammographic or sonographic abnormality corresponding to the palpable\nabnormality of concern at the 1:00 position of the left breast approximately\n3-4 cm from the nipple.\n\nRECOMMENDATION(S): Diagnostic left breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BREAST ULTRASOUND: Targeted ultrasound was performed of the bilateral\npalpable abnormalities.\n\nRight breast:\n\nAt the 9 o'clock position 11 cm from the nipple corresponding to 1 of the\npalpable abnormalities of concern, there is an approximately 1.2 x 0.9 x 1.2\ncm oval, circumscribed, hypoechoic mass with a thin hyperechoic rim and no\ninternal vascularity. This mass is in the area of the patient's lumpectomy\nscar.\n\nAt the 9 to 10:00 position of the right breast approximately 9 cm from the\nnipple, there is a 3.5 x 1.5 x 1.5 cm oval, circumscribed, isodense hypoechoic\nmass with little internal vascularity corresponding to an additional palpable\nabnormality of concern.\n\nLeft breast:\n\nAt the 11 o'clock position of the left breast approximately 2 cm from the\nnipple, there is an approximately 1.5 x 1.2 x 1.5 cm round, predominantly\nhyperechoic, heterogeneous mass with no internal vascularity corresponding to\none of the patient's palpable abnormalities of concern.\n\nAt the 1 o'clock position of the left breast approximately 3-4 cm from the\nnipple, no abnormal solid or cystic lesion is identified to correspond to one\nof the patient's palpable abnormalities of concern.\n\nAt the 5 o'clock position of the left breast approximately 5-6 cm from the\nnipple there is a 1.7 x 1.1 x 1.7 cm round, partially circumscribed partially\nindistinct heterogeneous mass with suggestion of a hyperechoic rim\ncorresponding to an additional palpable abnormality of concern.\n\nBB markers were then placed over the patient's palpable abnormalities of\nconcern within the bilateral breasts and mammography was obtained including\nspot tangent views.\n\n\nTissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\n\nRight breast:\n2 BB markers are visualized overlying the palpable abnormalities of concern in\nthe upper outer right breast in the region of the lumpectomy bed. The masses\nat the 9 o'clock position 11 cm from the nipple and the 9 to 10:00 position\napproximately 9 cm from the nipple on ultrasound correspond to areas of fat\nnecrosis as confirmed on the mammogram. Also noted are postsurgical changes\nwithin this area including surgical clips.\n\nLeft breast:\n2 BB markers are visualized overlying the palpable abnormalities of concern\nwithin the lower central left breast and upper inner left breast. The mass at\nthe 11 o'clock position of the left breast approximately 2 cm on ultrasound\ncorresponds to an area of fat necrosis on mammography. No suspicious\nabnormality is visualized at the 1 o'clock position 3-4 cm from the nipple. \nThe mass at the 5 o'clock position of the left breast approximately 5 cm from\nthe nipple on the ultrasound corresponds to an asymmetry visualized within the\ninferior left breast on the MLO view without definite correlate on the CC\nview. This is probably benign and likely represents fat necrosis.", + "output": "1. 1.7 x 1.1 x 1.7 cm probably benign mass at the 5 o'clock position of the\nleft breast 5-6 cm from the nipple. This likely represents fat necrosis. \nHowever, diagnostic left breast ultrasound is recommended in 6 months to\nensure stability.\n2. Palpable abnormalities at the 9 o'clock and 9 to 10:00 position of the\nright breast, as described above, correspond to areas of fat necrosis as\nconfirmed on mammography.\n3. Palpable abnormality at the 11 o'clock position of the left breast\napproximately 2 cm from the nipple, as described above, corresponds to an area\nof fat necrosis as confirmed on mammography.\n4. No mammographic or sonographic abnormality corresponding to the palpable\nabnormality of concern at the 1:00 position of the left breast approximately\n3-4 cm from the nipple.\n\nRECOMMENDATION(S): Diagnostic left breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound was performed in the area of the lump medially underlying\nthe patient's scar. In this area there is a 1.2 x 0.8 x 1.2 cm lymph node\ncontaining a HydroMARK coil clip corresponding to the previously sampled lymph\nnode which was positive for malignancy. The cortical thickness of the lymph\nnode currently measures approximately 3-4 mm. This has significantly\ndecreased in size compared to the prior ultrasound from ___ when\nthe node measured 3.6 x 2.3 x 3.0 cm. The lymph node is similar in size\ncompared to post neoadjuvant chemotherapy MRI from ___ when it\nmeasured 1.4 x 0.9 x 1.1 cm.", + "output": "Palpable lump in the right axilla corresponding to previously sampled right\naxillary lymph node positive for malignancy.\n\nRECOMMENDATION(S): Treatment as per the patient's surgical team.\n\nThe patient is also due for six-month follow-up mammogram and ultrasound in\n___ for probably benign findings.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nFindings discussed with ___ Rose-NP via telephone by ___\n___, MD on ___ at approximately 11:30.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Preliminary images re-demonstrate a in lymph node measuring 1.2 cm in the\ngreatest diameter containing a marker clip in the right lower axilla. This\nwill be targeted for localization.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained. The patient's\nallergies and medications were reviewed. A pre-procedure time-out was\nperformed using three patient identifiers, with confirmation of side and site.\n\nThe patient' s right axilla was scanned and the lymph node and clip\nidentified. Using standard aseptic technique, and ___ cc of 1% lidocaine for\nlocal anesthesia, a localizing needle and subsequently a wire were placed\nthrough the lesion under ultrasound guidance from the medial approach. As\nrequested the hook of the wire was deployed within the target.\n\nMammography was deferred.\n\nThe patient tolerated the procedure well. There were no immediate\ncomplications. She was sent to the operating room with printed, annotated\nimages.", + "output": "Technically successful ultrasound wire localization of right low axillary\nlymph node." + }, + { + "input": "RIGHT BREAST:\n\nA heterogeneously echogenic, avascular mass at 9 o'clock 11 cm from the nipple\nmeasuring 1.0 x 0.6 x 1.0 cm is unchanged from prior.\n\nTwo adjacent, stable masses are seen at ___ o'clock, 9 cm from the nipple. \nThe more superior mass is circumscribed, heterogeneously echogenic, and\nmeasures 1.5 x 0.9 x 1.4 cm. The more inferior mass is partially\ncircumscribed and predominantly hyperechoic measuring 1.4 x 0.9 x 1.2 cm.\n\nLEFT BREAST:\n\nAt 11 o'clock 2 cm from the nipple, the previously described hyperechoic mass\nis no longer seen.\n\nAt 5 o'clock 6 cm from the nipple, previously described hyperechoic area is no\nlonger appreciated.", + "output": "1. Three stable right breast masses most consistent with fat necrosis are\nunchanged in comparison with ___.\n2. Previously noted left breast masses are no longer appreciated.\n\nRECOMMENDATION(S): Six-month follow-up targeted right breast ultrasound. The\ndecision to perform concurrent mammography should be determined by the\npatient's clinical provider.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound was performed of the low right axilla in the area of\nconcern as indicated by the patient. There is a 2.5 x 1.5 x 3.2 cm anechoic,\navascular fluid collection compatible with a seroma.", + "output": "Right axillary postoperative seroma. This can be aspirated for symptom relief\nif desired.\n\nRECOMMENDATION(S): Clinical follow-up. Additionally the patient is due for\nultrasound follow-up of areas of fat necrosis in the right breast in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n Findings emailed to ___, NP by ___, MD on ___\n\nBI-RADS: 2 Benign." + }, + { + "input": "1. Hypoechoic vascular mass within the right chest wall measuring 1.9 x 3.1 x\n4.8 cm.\n2. Right-sided pleural effusion, partially imaged.", + "output": "Technically successful ultrasound-guided biopsy of right-sided chest wall\nmass. 4 specimens (22 mm 18 gauge cores) were submitted to pathology in 2\nseparate formalin containers. No immediate postprocedure complication." + }, + { + "input": "Multi abnormal supraclavicular lymph nodes identified with a rounded abnormal\nmorphology and thickened cortex, with the largest lymph node measuring 1.1 cm\nin width. This was selected for biopsy.", + "output": "Successful ultrasound-guided biopsy of enlarged abnormal supraclavicular lymph\nnode. No immediate post-procedure complication." + }, + { + "input": "Liver: The hepatic parenchyma is coarsened and nodular. Assessment for focal\nliver lesion, especially in the right hepatic lobe, is markedly limited due to\noverlying bowel gas. There is no ascites.\n\nBile ducts: There is no intrahepatic biliary ductal dilation. The common\nbile duct is poorly visualized.\n\nGallbladder: Gallbladder is not distended. Known gallstones, previously\ncharacterized on CT abdomen pelvis ___ are poorly evaluated.\n\nPancreas: The imaged portion of the pancreas appears within normal limits,\nwith portions of the pancreatic tail obscured by overlying bowel gas.\n\nSpleen: The spleen demonstrates normal echotexture, and measures 12.9 cm\n\nDoppler evaluation:\n\nLimited assessment due to overlying bowel gas and limited acoustic windows.\nThe main portal vein where visualized appears patent, with flow in the\nappropriate direction.\nMain portal vein velocity is 14.8 cm/sec.\nRight and left portal veins are patent, with antegrade flow.\n\nVery limited assessment of the main hepatic artery, but there is suggestion of\narterial waveforms in the porta hepatis.\nVery limited assessment of the hepatic veins, but there is normal color flow\nand waveforms in the right, middle and left hepatic veins.\n\nSplenic vein and superior mesenteric vein are patent, with antegrade flow.\n\nAgain noted is a recannulized umbilical vein.", + "output": "1. Very limited assessment due to overlying bowel gas but the portal vein\nappears patent with normal hepatopetal flow. Very limited assessment the main\nhepatic artery, but there is suggestion of arterial waveforms in the porta\nhepatis. Very limited assessment, but there is normal color flow and\nwaveforms in the middle, left, and right hepatic veins.\n2. Patient's known gallstones, characterized on CT abdomen pelvis ___ are poorly assessed on this study.\n3. Cirrhotic liver." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 100, 88, and 54 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 85 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 106 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 92, 60, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 40 cm/sec.\nThe ICA/CCA ratio is 0.91.\nThe external carotid artery has peak systolic velocity of 59 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "Grayscale, color and pulse wave Doppler sonograms were performed on\nthe left internal jugular, subclavian, axillary, brachial, basilic and\ncephalic veins. There is occlusive, non-compressible thrombus involving the\naxillary, brachial, and basilic veins. The left internal jugular vein\ncompresses normally, but markedly slow flow is seen within this vessel. Slow\nflow is also demonstrated in the left subclavian vein. Normal flow and\nwaveforms are noted in the contralateral right subclavian vein.", + "output": "Extensive DVT in the left upper extremity, involving the left\naxillary, brachial, and basilic veins. Slow flow is noted in the left\ninternal jugular and subclavian veins, but these vessels remain compressible." + }, + { + "input": "A 7 x 8 x 7 mm heterogeneously hypoechoic lesion is seen in the subcutaneous\ntissues of the right elbow, involving the vermis, with through transmission\nand internal blood flow, mostly seen in the periphery of the lesion. The\npatient reported mild pain during the scan.", + "output": "Findings compatible with infected sebaceous/epidermal inclusion cyst." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild partially calcified atherosclerotic\nplaque in the right bulb and proximal internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 65, 65, and 60 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.78.\nThe external carotid artery has peak systolic velocity of 87 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild partially calcified atherosclerotic\nplaque in the left bulb and proximal internal carotid artery. Atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 79 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 96, 79, and 62 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 103 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No significant carotid arterial stenosis. Mild partially calcified\natherosclerotic plaque in the bilateral bulbs and proximal internal carotid\narteries." + }, + { + "input": "Targeted ultrasound of the right breast at 10 o'clock 10 cm from the nipple\ndemonstrates a group of 3 cysts, the largest of which measures 7 mm x 5 mm x 8\nmm. Together the 3 cysts measure 10 x 5 x 8 mm. An adjacent 2 mm cyst is\nseen. There is no dominant vascularity to the cysts or internal septation of\nthe 3 cysts.", + "output": "No evidence of malignancy. Right breast cysts.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Mammogram:\nTissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Triangular markers correspond to fatty tissue in the\naxillary regions.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the areas of focal\npain in both axillary regions. Palpable areas of concern correspond to fatty\ntissue. There are no suspicious solid or cystic masses to correspond to\npalpable areas of concern. Normal-appearing axillary lymph nodes were also\nnoted.", + "output": "Fatty tissue corresponds to palpable areas of concern. No specific\nmammographic evidence of breast malignancy.\n\nRECOMMENDATION(S): Clinical followup for palpable areas of concern. Annual\nscreening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Mammogram:\nTissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Triangular markers correspond to fatty tissue in the\naxillary regions.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the areas of focal\npain in both axillary regions. Palpable areas of concern correspond to fatty\ntissue. There are no suspicious solid or cystic masses to correspond to\npalpable areas of concern. Normal-appearing axillary lymph nodes were also\nnoted.", + "output": "Fatty tissue corresponds to palpable areas of concern. No specific\nmammographic evidence of breast malignancy.\n\nRECOMMENDATION(S): Clinical followup for palpable areas of concern. Annual\nscreening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 2 18-gauge core biopsy passes were made. \nThe sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n0.5 mg Versed and 25 mcg fentanyl throughout the total intra-service time of\n14 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to\npathology." + }, + { + "input": "The aorta measures 2.2 x 2.0 cm in the proximal portion, 2.2 x 1.9 cm in mid\nportion and 2.0 x 2.0 cm in the distal abdominal aorta. There is mild\ncalcified atherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.7 cm and the left common iliac artery\nmeasures 0.8 cm.\n\nThe right kidney measures 10.2 cm and the left kidney measures 11.2 cm. \nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "Grayscale, color, and spectral doppler imaging was obtained of the right and\nleft common femoral, femoral, and popliteal veins. Normal flow,\ncompressibility, augmentation, and waveforms are demonstrated. No intraluminal\nthrombus is identified. Normal color flow and compressibility are demonstrated\nin the posterior tibial and peroneal veins. There is normal respiratory\nvariation in both common femoral veins. No ___ cyst is seen.\nThere is calf edema on the right.", + "output": "No evidence of deep vein thrombosis in right or left lower extremity." + }, + { + "input": "Grayscale, color, and spectral doppler imaging was obtained of the right and\nleft common femoral, femoral, and popliteal veins. Normal flow,\ncompressibility, augmentation, and waveforms are demonstrated. No intraluminal\nthrombus is identified. Normal color flow and compressibility are demonstrated\nin the bilateral posterior tibial and peroneal veins. The left posterior\ntibial and peroneal veins are not visualized There is normal respiratory\nvariation in both common femoral veins. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis in right or left lower extremity." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 62, 69, and 100 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 121 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 72 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 81, 86, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild plaque. Bilateral ___ stenosis." + }, + { + "input": "There is redemonstration of the left parotid gland heterogeneous hypoechoic\nmass measuring 1.1 cm x 1.0 cm. This was targeted for fine needle aspiration", + "output": "Successful fine needle aspiration of the left parotid gland mass, with no\nimmediate post-procedural complications." + }, + { + "input": "Edema and fluid is seen layering in the lateral breast. No evidence of large\ndiscrete abscess, however small abscess cannot be excluded, recommend\nfollow-up and further evaluation with breast surgeon.", + "output": "As above." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are new postsurgical changes involving the inner right breast compatible\nwith surgical excision. There are grouped heterogeneous calcifications within\nthe outer right breast mid depth which are new compared to the prior mammogram\nthe spanning approximately 0.3 cm. These calcifications are indeterminate and\nstereotactic biopsy is recommended.\n\nThere are faint grouped microcalcifications within the lower inner right\nbreast anterior depth spanning approximately 0.3 cm which also appear new\ncompared to the prior mammogram. These calcifications may be layering on the\nlateral view suggesting benign milk of calcium.\n\nAdditional scattered benign appearing calcifications are seen throughout the\nright breast. There is a 1.2 cm circumscribed round low-density mass within\nthe upper outer right breast which has the appearance of an intramammary lymph\nnode but is larger when compared to the prior mammogram. Ultrasounds\nperformed for further evaluation.\n\nNo additional dominant mass, unexplained architectural distortion, or\nsuspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: At 11 o'clock right breast 13 cm from the nipple there is\na rounded 1.2 x 1.1 x 0.6 cm intramammary lymph node with increased color flow\ncorresponding to mammographic Findings is indeterminate. Ultrasound-guided\ntissue sampling is recommended.", + "output": "1. New grouped heterogeneous calcifications within the outer right breast mid\ndepth which are indeterminate and stereotactic biopsy is recommended. 2. \nAdditional group of faint microcalcifications within the lower inner right\nbreast which may be layering on the lateral view and are probably benign. \nSix-month follow-up mammogram is recommended to ensure stability if biopsy\nresults of other calcifications are benign.\n3. 1.2 cm rounded intramammary lymph node 11 o'clock right breast with\nincreased color flow which is demonstrated interval enlargement compared to\nprior imaging is indeterminate and therefore ultrasound-guided tissue sampling\nis recommended..\n\nRECOMMENDATION(S): 1. Stereotactic biopsy indeterminate calcifications outer\nright breast.\n2. Ultrasound-guided FNA/biopsy enlarging intramammary lymph node 11 o'clock\nright breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. The findings were communicated to ___, M.D. by ___\n___, M.D. by email on ___ at 4:58 pm.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are new postsurgical changes involving the inner right breast compatible\nwith surgical excision. There are grouped heterogeneous calcifications within\nthe outer right breast mid depth which are new compared to the prior mammogram\nthe spanning approximately 0.3 cm. These calcifications are indeterminate and\nstereotactic biopsy is recommended.\n\nThere are faint grouped microcalcifications within the lower inner right\nbreast anterior depth spanning approximately 0.3 cm which also appear new\ncompared to the prior mammogram. These calcifications may be layering on the\nlateral view suggesting benign milk of calcium.\n\nAdditional scattered benign appearing calcifications are seen throughout the\nright breast. There is a 1.2 cm circumscribed round low-density mass within\nthe upper outer right breast which has the appearance of an intramammary lymph\nnode but is larger when compared to the prior mammogram. Ultrasounds\nperformed for further evaluation.\n\nNo additional dominant mass, unexplained architectural distortion, or\nsuspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: At 11 o'clock right breast 13 cm from the nipple there is\na rounded 1.2 x 1.1 x 0.6 cm intramammary lymph node with increased color flow\ncorresponding to mammographic Findings is indeterminate. Ultrasound-guided\ntissue sampling is recommended.", + "output": "1. New grouped heterogeneous calcifications within the outer right breast mid\ndepth which are indeterminate and stereotactic biopsy is recommended. 2. \nAdditional group of faint microcalcifications within the lower inner right\nbreast which may be layering on the lateral view and are probably benign. \nSix-month follow-up mammogram is recommended to ensure stability if biopsy\nresults of other calcifications are benign.\n3. 1.2 cm rounded intramammary lymph node 11 o'clock right breast with\nincreased color flow which is demonstrated interval enlargement compared to\nprior imaging is indeterminate and therefore ultrasound-guided tissue sampling\nis recommended..\n\nRECOMMENDATION(S): 1. Stereotactic biopsy indeterminate calcifications outer\nright breast.\n2. Ultrasound-guided FNA/biopsy enlarging intramammary lymph node 11 o'clock\nright breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. The findings were communicated to ___, M.D. by ___\n___, M.D. by email on ___ at 4:58 pm.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Ultrasound of the right axillary tail at 10 o'clock 10 cm from the nipple\nre-identified an oval circumscribed hypoechoic mass (previously labeled 11\no'clock, 13 cm from the nipple) which was targeted for ultrasound-guided\nbiopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P and ___, MD. ___ procedure was\nsupervised by ___, M.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: 2 cores to pathology, 2 cores to hemopathology, 2 cores to\ncytogenetics.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement and expected post biopsy changes. No significant hematoma seen.", + "output": "Technically successful US-guided core biopsy of the mass in the upper outer\nposterior right breast.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations. Note that the patient also underwent stereotactic core\nbiopsy of the right breast for calcifications at the same visit.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nresident's findings and dictation." + }, + { + "input": "Ultrasound of the right axillary tail at 10 o'clock 10 cm from the nipple\nre-identified an oval circumscribed hypoechoic mass (previously labeled 11\no'clock, 13 cm from the nipple) which was targeted for ultrasound-guided\nbiopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P and ___, MD. ___ procedure was\nsupervised by ___, M.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: 2 cores to pathology, 2 cores to hemopathology, 2 cores to\ncytogenetics.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement and expected post biopsy changes. No significant hematoma seen.", + "output": "Technically successful US-guided core biopsy of the mass in the upper outer\nposterior right breast.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations. Note that the patient also underwent stereotactic core\nbiopsy of the right breast for calcifications at the same visit.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nresident's findings and dictation." + }, + { + "input": "BREAST ULTRASOUND: Targeted ultrasound 11 o'clock position of the\nreconstructed left breast at site of palpable abnormality as indicated by the\npatient demonstrates a 0.7 x 0.6 by 0.5 cm avascular round circumscribed\npredominantly anechoic mass with dependent echogenicity likely representing\ndebris. There are echogenic foci along its anterior wall suggestive of\ncalcification. Overall imaging characteristics favor benign fat necrosis/oil\ncyst and was further evaluated with mammographic views.\n\nTissue density: A- The breast tissue is almost entirely fatty.\nMetallic BB denotes site of palpable abnormality within the left breast. Deep\nto the marker at the 11 o'clock position there is 0.9 cm circumscribed mass\nwith central fat lucency and rim calcification compatible with benign fat\nnecrosis/oil cyst and corresponds to the sonographic Findings.", + "output": "Benign fat necrosis/oil cyst corresponding to palpable lump at 11:00 position\nin the constructed left breast.\n\nRECOMMENDATION(S): Clinical follow-up area of concern left constructed\nbreast.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "BREAST ULTRASOUND: Targeted ultrasound 11 o'clock position of the\nreconstructed left breast at site of palpable abnormality as indicated by the\npatient demonstrates a 0.7 x 0.6 by 0.5 cm avascular round circumscribed\npredominantly anechoic mass with dependent echogenicity likely representing\ndebris. There are echogenic foci along its anterior wall suggestive of\ncalcification. Overall imaging characteristics favor benign fat necrosis/oil\ncyst and was further evaluated with mammographic views.\n\nTissue density: A- The breast tissue is almost entirely fatty.\nMetallic BB denotes site of palpable abnormality within the left breast. Deep\nto the marker at the 11 o'clock position there is 0.9 cm circumscribed mass\nwith central fat lucency and rim calcification compatible with benign fat\nnecrosis/oil cyst and corresponds to the sonographic Findings.", + "output": "Benign fat necrosis/oil cyst corresponding to palpable lump at 11:00 position\nin the constructed left breast.\n\nRECOMMENDATION(S): Clinical follow-up area of concern left constructed\nbreast.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 85, 79, and 74 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 46 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 65 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 64, 57, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 14 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 55 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the bilateral internal carotid arteries." + }, + { + "input": "Mammogram:\nTissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\nAgain seen is an approximately 1 cm equal density partially circumscribed mass\nin the outer left breast at posterior depth, previously shown to represent a\nsimple cyst. There have been interval development of new equal density\npartially circumscribed masses measuring 1 cm in smaller in the outer left\nbreast at anterior and middle depth. There are no new suspicious\ncalcifications or areas of architectural distortion in either breast. There\nare no new suspicious masses in the right breast.\n\nUltrasound of the left breast:\n\nTargeted ultrasound of the left breast was performed. There are multiple\nsimple cysts throughout the outer left breast. In the 3 o'clock position 0-1\ncm from the nipple there is a dominant 10 x 5 x 11 mm oval circumscribed\nanechoic mass with increased through transmission and no internal vascularity,\nconsistent with a simple cyst. Multiple additional smaller cysts are noted in\nthe ___ o'clock axis, corresponding to the mammographic masses. Additionally,\nthere is a 1 cm well circumscribed anechoic mass consistent with a simple cyst\nin the 4 o'clock position approximately 5 cm from the nipple, corresponding to\nthe dominant mammographic mass at posterior depth.", + "output": "No definite mammographic or sonographic evidence of malignancy. Multiple\nbenign simple cysts throughout the outer left breast.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Mammogram:\nTissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\nAgain seen is an approximately 1 cm equal density partially circumscribed mass\nin the outer left breast at posterior depth, previously shown to represent a\nsimple cyst. There have been interval development of new equal density\npartially circumscribed masses measuring 1 cm in smaller in the outer left\nbreast at anterior and middle depth. There are no new suspicious\ncalcifications or areas of architectural distortion in either breast. There\nare no new suspicious masses in the right breast.\n\nUltrasound of the left breast:\n\nTargeted ultrasound of the left breast was performed. There are multiple\nsimple cysts throughout the outer left breast. In the 3 o'clock position 0-1\ncm from the nipple there is a dominant 10 x 5 x 11 mm oval circumscribed\nanechoic mass with increased through transmission and no internal vascularity,\nconsistent with a simple cyst. Multiple additional smaller cysts are noted in\nthe ___ o'clock axis, corresponding to the mammographic masses. Additionally,\nthere is a 1 cm well circumscribed anechoic mass consistent with a simple cyst\nin the 4 o'clock position approximately 5 cm from the nipple, corresponding to\nthe dominant mammographic mass at posterior depth.", + "output": "No definite mammographic or sonographic evidence of malignancy. Multiple\nbenign simple cysts throughout the outer left breast.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Distended gallbladder with cholelithiasis, mural thickening and a positive\n___ sign consistent with an acute cholecystitis.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples were sent for microbiology evaluation." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is no dominant mass at 11 o'clock in the left breast. There are rounded\nareas of parenchymal asymmetry measuring 14 mm and 9 mm in the superior left\nbreast on the MLO and ML views, without associated microcalcification. These\ncorrespond to areas of glandular tissue seen on same date ultrasound.\nBoth breasts are without suspicious dominant mass, architectural distortion or\ngrouped microcalcification.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 11 o'clock\ndemonstrates normal dense parenchyma. Scanning of the entire left upper\nbreast demonstrates dense glandular tissue, with a focal lobule of glandular\ntissue seen at 1 o'clock 9-10 cm from the nipple consistent with normal\nparenchyma.", + "output": "No mammographic or ultrasound evidence of malignancy.\n\nRECOMMENDATION: Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Within the subcutaneous soft tissues just deep to the subcutaneous fat there\nis a hypoechoic mass measuring 4.8 (craniocaudal) x 1.0 (anterior-posterior) x\n6.1 (transverse) cm without associated internal vascularity consistent with a\nlipoma, as seen on the previous MRI exam. There has been interval increase in\nsize of the lesion (previously 3.3 x1.3 x 2.5 cm). No additional mass is seen.", + "output": "Interval increase in size of a subcutaneous lipoma within the soft tissues of\nthe left upper back." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 100 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 97, 91, and 106 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 45 cm/sec.\nThe ICA/CCA ratio is 1.08.\nThe external carotid artery has peak systolic velocity of 71 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 93 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 62, 79, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 41 cm/sec.\nThe ICA/CCA ratio is 0.92.\nThe external carotid artery has peak systolic velocity of 63 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Stable right ICA dissection is not flow limiting.\n2. Arterial carotid velocities are normal bilaterally." + }, + { + "input": "There is redemonstration of an encapsulated, oblong mass within the\nsubcutaneous soft tissues of the left upper back isoechoic to the adjacent\nsubcutaneous fat. The lesion now measures 6.3 x6.3 x 1.2 cm (previously 4.8 x\n6.0 x 1.0 cm on the ultrasound of ___ and 3.3 x 2.5 x 1.3 cm on\nthe MRI of ___. Additionally, a focus of internal vascularity is\nvisualized within the mass which was not definitely seen on previous exams\n(series 1 a image 9). No additional internal vascular or soft tissue nodular\ncomponents are seen.", + "output": "Mild interval increase in size of a fat containing lesion within the\nsubcutaneous soft tissues of the left upper back. There is a new focus of\ninternal vascularity demonstrated within the lesion which was not definitely\nseen on previous exams without demonstration of additional concerning internal\nfeatures, an atypical lipomatous lesion cannot be excluded." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications. Diffuse distortion is noted consistent with\nprior reduction. There has been no significant change.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses. Accessory breast tissue is noted\nin the right axilla.", + "output": "No evidence malignancy.\n\nRECOMMENDATION(S): Further management of the patient's breast pain should be\nbased on clinical assessment. Patient will be due for routine annual\nscreening in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 69, 65, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 53.2 cm/sec.\nThe vertebral artery is patent with antegrade flow. There is again an\napproximately 4 mm dissection in the right internal carotid artery, without\nevidence of limiting flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 51, 46, and 44 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.58.\nThe external carotid artery has peak systolic velocity of 56 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. The known dissection in the right ICA is similar to the prior exam in ___\nand is not flow limiting.\n2. Arterial carotid velocities are normal bilaterally." + }, + { + "input": "There is moderate amount of right-sided pleural effusion. Given the patient's\nhealth status, it was decided to do a portable chest tube placement under\nultrasound guidance to try and drain as much as possible to improve patient's\nrespiratory status as opposed to CT-guided chest tube placement.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight: The right breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications. There are\nbenign-appearing calcifications including secretory calcifications throughout\nthe parenchyma.\nThe area of prior asymmetry was overlapping glandular tissue as normal\nparenchyma is seen on spot compression and tomosynthesis slices today.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right lateral breast was\nperformed from 6 o'clock through 12 o'clock. The breast parenchyma\ndemonstrates scattered fibroglandular elements without suspicious solid or\ncystic mass. Incidentally noted at 6 o'clock 0-1 cm from the nipple is duct\nectasia with ducts measuring 5-6 mm in diameter.", + "output": "No specific evidence of malignancy in the right breast.\nIncidental duct ectasia at 6 o'clock.\n\nRECOMMENDATION(S): Return to age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight: The right breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications. There are\nbenign-appearing calcifications including secretory calcifications throughout\nthe parenchyma.\nThe area of prior asymmetry was overlapping glandular tissue as normal\nparenchyma is seen on spot compression and tomosynthesis slices today.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right lateral breast was\nperformed from 6 o'clock through 12 o'clock. The breast parenchyma\ndemonstrates scattered fibroglandular elements without suspicious solid or\ncystic mass. Incidentally noted at 6 o'clock 0-1 cm from the nipple is duct\nectasia with ducts measuring 5-6 mm in diameter.", + "output": "No specific evidence of malignancy in the right breast.\nIncidental duct ectasia at 6 o'clock.\n\nRECOMMENDATION(S): Return to age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 14 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left native kidney biopsy." + }, + { + "input": "A cluster of mildly enlarged lymph nodes were seen in the left inguinal\nregion, largest measuring 1.9 cm in size. These likely correspond with the\nabnormality seen on the recent PET-CT. This mildly enlarged lymph node was\ntargeted for the ultrasound-guided lymph node biopsy.", + "output": "Successful ultrasound-guided lymph node biopsy from the left inguinal region." + }, + { + "input": "An enlarged left inguinal lymph was targed for biopsy. The lymphoma biopsy\nprotocol was used as directed by an on-site cytologist.", + "output": "Successful ultrasound-guided left inguinal lymph node biopsy. Pathology\npending." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. Enlarged left inguinal lymph node was identified. A suitable\napproach for biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues were anesthetized\nwith 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, two 18-gauge core biopsy passes were\nmade. The samples were provided to the on-site cytologist who indicated an\nadequate sample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: None.", + "output": "Uncomplicated 18-gauge left inguinal lymph node biopsy x 2, with specimens\nprovided to the cytologist." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: right upper quadrant\nFluid: 20 cc of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a spinal needle advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 20 cc of fluid were removed and sent for analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right mid\nabdomen was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic and diagnostic paracentesis\nLocation: Right mid abdomen\nFluid: 3 L of blood-tinged fluid\nSamples: Sample sent for microbiology, hematology and chemistry evaluations.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided paracentesis yielding blood-tinged\nfluid. 3 L of ascites removed, limit of the amount that was permitted." + }, + { + "input": "Right breast tissue density: C- The breast tissue is heterogeneously dense\nwhich may obscure detection of small masses.\nBoth breasts are without suspicious dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. In particular, there is no right\nretroareolar mass identified.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 8 o'clock 1 cm\nfrom the nipple demonstrates a 5 x 3 x 4 mm cluster of microcysts which are\nwithout dominant vascularity and demonstrate internal septation. Targeted\nultrasound of the right breast at 8 o'clock 5 cm from the nipple demonstrates\na 4 x 2 x 4 mm cyst with some minimal debris. Prominent ducts are noted in\nthe retroareolar region in particular at 9 and 8 o'clock. There is no\nintraductal mass identified.\nAt the time of the ultrasound, the patient complained of an area of concern in\nthe right breast at 8 o'clock and 9 o'clock 7 cm from the nipple. This area\ndemonstrates scattered fibroglandular tissue.", + "output": "5 mm right breast microcysts at 8 o'clock 1 cm from the nipple.\n4 mm cyst with debris at 8 o'clock 5 cm from the nipple.\n\nRECOMMENDATION(S): Six-month follow-up right breast ultrasound is recommended\nat this time.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At 8:00 position 1 cm from the nipple there is a 4 x 4 x 2 mm group of\nmicrocysts, unchanged since prior examination. At 8:00 position 5 cm from the\nnipple there is an oval parallel hypoechoic mass measuring 4 mm, likely\ncomplicated cyst, also unchanged since prior examination.", + "output": "Six-month stability of 2 probably benign masses in right breast.\n\nRECOMMENDATION(S): Continued follow-up is recommended in 6 months with right\nbreast ultrasound at the time of annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is an asymmetry in the lateral left breast at middle to posterior depth\nwhich disperses with spot compression and tomosynthesis, consistent with\nsuperimposition of benign parenchyma. No suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast was performed in\nthe areas of sonographic masses identified on prior studies. At the 8 o'clock\nposition of the right breast 5 cm from the nipple, there is a 4 x 4 x 2 mm\ncyst with possible thin internal septation, not significantly changed in\ncomparison to prior studies dating to ___. At the 8 o'clock position 1\ncm from the nipple, there is a 5 x 3 x 2 mm cluster of microcysts. No\nsuspicious solid or cystic mass.", + "output": "Right breast cyst and clustered microcysts are benign, stable on ultrasound\nfor ___ year. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings reviewed with the patient by the technologist at the\ncompletion of the exam..\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is an asymmetry in the lateral left breast at middle to posterior depth\nwhich disperses with spot compression and tomosynthesis, consistent with\nsuperimposition of benign parenchyma. No suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast was performed in\nthe areas of sonographic masses identified on prior studies. At the 8 o'clock\nposition of the right breast 5 cm from the nipple, there is a 4 x 4 x 2 mm\ncyst with possible thin internal septation, not significantly changed in\ncomparison to prior studies dating to ___. At the 8 o'clock position 1\ncm from the nipple, there is a 5 x 3 x 2 mm cluster of microcysts. No\nsuspicious solid or cystic mass.", + "output": "Right breast cyst and clustered microcysts are benign, stable on ultrasound\nfor ___ year. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings reviewed with the patient by the technologist at the\ncompletion of the exam..\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT BREAST: The whole right breast was scanned. Static images at 12\no'clock, 3 o'clock, 6 o'clock, and 9 o'clock, 1-12 cm from nipple, as well as\nin the retroareolar region and right axilla were obtained. No suspicious\nsolid or cystic mass identified. Normal appearing axillary lymph node.\n\nLEFT BREAST:The whole left breast was scanned. Static images at 12 o'clock, 3\no'clock, 6 o'clock, and 9 o'clock, 1-12 cm from the nipple, as well as in the\nretroareolar region and right axilla were obtained. No suspicious solid or\ncystic mass identified. Normal appearing axillary lymph node.", + "output": "No suspicious solid or cystic mass identified in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Preprocedure scan demonstrated a 2.6 x 1.5 cm heterogenous lymph node in the\nleft lower neck, adjacent to the common carotid artery.", + "output": "Uncomplicated core biopsy of a left cervical lymph node as above." + }, + { + "input": "There is a suspicious left level 4 cervical lymph node measuring 4.5 x 2.7 x\n2.8 cm. The lymph node is hypervascular, heterogeneous, with areas of cystic\nchange and loss of a normal fatty hilum. There was an adjacent superficial\nround lymph node measuring 9 x 10 mm which also appeared suspicious.", + "output": "Technically successful ultrasound guided left level 4 cervical lymph node\nbiopsy." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere is an approximately 6 mm oval asymmetry in the slightly upper outer\nright breast with no associated calcifications or distortions. This asymmetry\nis more conspicuous compared with ___.\n\nBREAST ULTRASOUND: Ultrasound of the outer right breast was performed. 09:30\nposition 4 cm from the nipple there is a 4 mm oval mass which likely\ncorresponds to the mammographic asymmetry.", + "output": "There is an indeterminate 4 mm mass at 09:30 position 4 cm from the nipple in\nthe right breast for which ultrasound-guided core needle biopsy is recommended\nfor tissue diagnosis.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. She was given information to schedule her biopsy. \nThe impression and recommendation above was entered by Dr. ___\non ___ at 12:39 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "At the 9:30 o'clock position of the right breast 4 cm from the nipple, there\nis a 4 x 5 x 2 mm oval hypoechoic mass targeted for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "At the 9:30 o'clock position of the right breast 4 cm from the nipple, there\nis a 4 x 5 x 2 mm oval hypoechoic mass targeted for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Tissue density: C- The breast tissues are heterogeneously dense, which may\nobscure visualization of small masses.\n\nNo evidence right breast dominant mass, unexplained architectural distortion,\nor concerning grouped microcalcifications. No significant change since\nscreening mammogram.\n\nBREAST ULTRASOUND: Targeted breast ultrasound from the 6 o'clock to the 9\no'clock position, ranging from 1 cm to 10 cm from the nipple, in the area of\nmost significant pain, was performed. No evidence of solid or cystic mass.", + "output": "No specific evidence of malignancy. No etiology identified for right breast\npain.\n\nRECOMMENDATION: Screening mammography.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 64, 60, and 61 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 22\ncm/sec.\nThe ICA/CCA ratio is 0.74.\nThe external carotid artery has peak systolic velocity of 114 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 98 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 57, 60, and 71 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 22\ncm/sec.\nThe ICA/CCA ratio is 0.72.\nThe external carotid artery has peak systolic velocity of 87 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: There are scattered areas of fibroglandular density.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications. Multiple enlarged right axillary lymph nodes are\nseen, which have increased in size in conspicuity since prior mammograms..\n\nBILATERAL AXILLARY ULTRASOUND:\n\nRight: There are multiple pathologically enlarged axillary lymph nodes\nmeasuring up to 2.6 cm in largest dimension with abnormal morphology. The\nmajority of the nodes demonstrate thickened cortices and obliteration of fatty\nhila.\n\nLeft: No abnormal lymph nodes are detected.", + "output": "Right axillary lymphadenopathy is new since an ___ exam, for which\nultrasound-guided core biopsy is recommended for definitive diagnosis.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study. In addition, findings were discussed with Dr.\n___, at 11:00 ___ by phone immediately after discovery.\n\n\n\nBI-RADS: 4B Suspicious - moderate suspicion for malignancy." + }, + { + "input": "Targeted ultrasound of the right axilla again demonstrates several\nabnormal-appearing lymph nodes with cortical thickening, the largest measuring\n2.2 x 2.6 x 1 cm.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D. and ___, M.D.. The procedure was supervised by\n___, M.D. (Attending).\nDescription: Using aseptic technique and 1% lidocaine for local anesthesia, 6\npasses were made with 22 gauge needles into the largest suspicious right\naxillary lymph node as described above under ultrasound guidance. Three\npasses were were sent to cytology and an additional three samples were sent\nfor flow cytometry. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and Cytology\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost-procedure diagnosis: Same.", + "output": "Technically successful ultrasound-guided fine needle aspiration of the largest\nsuspicious right axillary lymph node. Specimens were sent for cytology and\nflow ctyometry. The patient expects to hear the pathology results from Dr.\n___, the referring provider, in ___ business days. Standard post-care\ninstructions were provided to the patient." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a circumscribed asymmetry best seen on the MLO and true lateral views\nin the 6 o'clock position of the right breast at anterior depth without\nassociated calcifications or distortion. There is a circumscribed oval\nasymmetry seen in the ___ o'clock position of the right breast at posterior\ndepth seen only on the CC view without associated calcifications or\narchitectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast in the areas of\nmammographic concern was performed. At 6 o'clock, 4 cm from the nipple there\nis a simple cyst measuring 4 mm x 2 mm x 4 mm. At 8 o'clock, 3-4 cm from the\nnipple there is a simple cyst measuring 9 mm x 3 mm x 5 mm. At 5 o'clock, 5\ncm from the nipple there is a simple cyst measuring 3 mm x 1 mm by 3 mm. The\ncyst at 6 o'clock and 5 o'clock correspond to the mammographic asymmetries. \nThere is no suspicious mass or suspicious sonographic finding.", + "output": "Simple cyst corresponding to the mammographic asymmetries.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a subtle 9 mm asymmetry noted in the left upper outer quadrant\nanterior depth approximately 1-2 cm from the nipple. This is without definite\nmass margins on tomosynthesis, but seen on spot MLO slice 24, and spot CC\nslice 24.\n\nBREAST ULTRASOUND: Targeted ultrasound of the patient's area of clinical\nconcern at ___ o'clock 0-1 cm from the nipple demonstrates heterogeneity to\nthe subcutaneous fat which is hyperechoic measuring 1.8 x 1.0 x 1.5 cm\ncontaining a small subcentimeter hypoechoic area measuring 5 x 4 mm. This\ndemonstrates slight prominence of the vascularity. Immediately adjacent and\nposterior to this in the left breast at 3 o'clock 1 cm from the nipple is a\n0.8 x 0.3 x 0.7 cm irregular hypoechoic mass which is along the anterior\nmargin of the breast parenchyma, without significant dominant vascularity. \nThis may represent the mammographic finding.", + "output": "Indeterminate left breast mass which corresponds to the patient's palpable\narea of concern. The mass is complex with both hyper and hypoechoic areas. \nIn addition there is a hypoechoic mass along the anterior margin of the\nparenchyma which is seen in the adjacent tissue, and may be contiguous with\nthe hyperechoic lesion. These areas could both be biopsied at the same time\nand/or with the same sampling needle.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy left breast at 3 o'clock,\nwith clip placement.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\nHer clinician's office will be contacted for appropriate biopsy orders.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "At 3 o'clock, 0-1 cm from the nipple there is a 1.1 x 1.9 x 0.8 cm hyperechoic\nill-defined mass. This was targeted for biopsy, and labeled \"left breast 3:00\nanterior\".\n\nAt 3 o'clock, 0-1 cm from the nipple there is a 0.6 x 0.3 x 0.6 cm irregular\nhypoechoic mass along the anterior margin of the breast parenchyma. This was\ntargeted for biopsy, and labeled \"left breast 3:00 posterior\".\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was\nsupervised by ___, M.D.(Attending).\n\nDescription:\nLEFT BREAST 3:00 ANTERIOR: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand 4 cores were obtained using a 14-gauge Bard spring-loaded biopsy device. \nThe needle was removed and hemostasis was achieved. A clip was not placed in\nthis lesion as it was palpable.\n\nLEFT BREAST 3:00 POSTERIOR: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand 4 cores were obtained using a 14-gauge Bard spring-loaded biopsy device. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology, labeled anterior and posterior.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof the single clip placed in the posterior lesion.", + "output": "Technically successful US-guided core biopsy of the left breast lesions. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "At 3 o'clock, 0-1 cm from the nipple there is a 1.1 x 1.9 x 0.8 cm hyperechoic\nill-defined mass. This was targeted for biopsy, and labeled \"left breast 3:00\nanterior\".\n\nAt 3 o'clock, 0-1 cm from the nipple there is a 0.6 x 0.3 x 0.6 cm irregular\nhypoechoic mass along the anterior margin of the breast parenchyma. This was\ntargeted for biopsy, and labeled \"left breast 3:00 posterior\".\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was\nsupervised by ___, M.D.(Attending).\n\nDescription:\nLEFT BREAST 3:00 ANTERIOR: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand 4 cores were obtained using a 14-gauge Bard spring-loaded biopsy device. \nThe needle was removed and hemostasis was achieved. A clip was not placed in\nthis lesion as it was palpable.\n\nLEFT BREAST 3:00 POSTERIOR: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand 4 cores were obtained using a 14-gauge Bard spring-loaded biopsy device. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology, labeled anterior and posterior.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof the single clip placed in the posterior lesion.", + "output": "Technically successful US-guided core biopsy of the left breast lesions. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Scans demonstrate a large heterogeneous hypoechoic solid mass in the\npancreatic tail with areas of necrosis. The mass measures approximately 3 x\n3.5 cm. Along the superficial cephalad margin of the mass are about both the\nsplenic vein and splenic artery which are and virtually immediate contact with\nthe mass. More distally these veins and arteries bifurcate heading towards the\nsplenic hilum. There is no evidence of vascular invasion and no satellite\nnodules seen. The more proximal body of the pancreas was scanned and an\nappropriate plane identified for surgical resection.", + "output": "3.5 cm solid mass in the pancreatic tail as described." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nLeft vertebral artery: Vessel caliber smooth and regular. There is acute\nthrombus at the origin of the basilar artery at the VB junction. There is\nsome contrast opacification distal but no contrast opacifies to the basilar\ntip or bilateral PCAs. There is reflux of contralateral vertebral artery\nwhich appears irregular in shape.\n\nLeft posterior cerebral artery micro injection: There is opacification the\ndistal posterior cerebral artery territory confirming location of\nmicrocatheter beyond the location of the thrombus.\n\nLeft vertebral artery after first pass: There is opacification of the basilar\nartery now and bilateral posterior cerebral arteries and bilateral superior\ncerebellar arteries. The top of the basilar was not previously identified or\nopacified on the previous imaging. There is still some clot ought of the VB\njunction there is good flow distal. There is reflux into the contralateral\nvertebral artery which does show irregularity in the caliber specifically\nright prior to the VB junction. There is some spasm and irregularity to the\ncaliber of the basilar artery as well.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "TICI 3, complete reperfusion of the affected territory after 1 pass with\nmechanical aspiration and stentriever basilar artery thrombus. There is still\nsome thrombus the VB junction but there is complete revascularization of the\nterritory with no delayed filling.\n\nRECOMMENDATION(S):\n1. Plan per neurology" + }, + { + "input": "Redemonstration of a thick-walled distended gallbladder with a stone noted in\nthe neck.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation.\n\nRECOMMENDATION(S): See POE for drain care recommendations." + }, + { + "input": "Large heterogeneous hypoechoic right axillary adenopathy measuring up to 4.5\ncm.", + "output": "Successful ultrasound-guided right exam early adenopathy biopsy. Specimen was\nsent in formalin and RPMI for lymphoma protocol to the pathology department." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\n There is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. No abnormalities identified breast in the area of\nsymptomatology.\n\n\nLEFT BREAST ULTRASOUND: Targeted sonography of the area of symptomatology as\ndirected by the patient as well as at 6 o'clock did not demonstrate any\ncystic, solid or shadowing findings.", + "output": "No mammographic evidence of malignancy.\n\nNo sonographic abnormality to account for the patient's left-sided pain.\n\nRECOMMENDATION(S): Risk and age based screening. Clinical evaluation of the\npatient's symptoms on the left side.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe asymmetries in the inferior left breast do not persist on the additional\nimaging and therefore are felt to have corresponded to superimposed breast\ntissue. The asymmetry in the lateral left breast is felt to correspond to a\nvessel on end on the tomosynthesis images.\n\nTargeted ultrasound of the left axilla in the area of concern as indicated by\nthe patient demonstrates a hypoechoic area measuring 1.1 x 0.8 x 0.7 cm with\nan echogenic and vascular rim and surrounding edema consistent with an\ninfection such as hidradenitis suppurativa. Clinical followup is recommended.", + "output": "1. Left breast asymmetry seen on recent screening ___ corresponding\nto superimposed breast tissue.\n2. Left axillary dermal mass suggestive of an infection such as hidradenitis\nsuppurativa corresponding to the area of concern as indicated by the patient. \nClinical follow-up is recommended..\n\nRECOMMENDATION(S):\nAnnual screening mammography. Clinical follow-up.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal calcified atherosclerotic plaque in\nthe proximal external carotid artery. No plaque identified in the internal\ncarotid artery.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n41/15 cm/sec in its proximal portion, 37/9 cm/sec in its mid portion, and 33/8\ncm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n37/10 cm/sec.\nThe external carotid artery has peak systolic velocity of 31 cm/sec.\nThe vertebral artery has peak systolic velocity of 37 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.1.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n34/11 cm/sec in its proximal portion, 52/14 cm/sec in its mid portion, and\n55/17 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 38/9\ncm/sec.\nThe external carotid artery has peak systolic velocity of 37 cm/sec.\nThe vertebral artery has peak systolic velocity of 32 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.4.", + "output": "Minimal calcified plaque in the proximal right external carotid artery. No\ninternal carotid artery stenosis identified bilaterally." + }, + { + "input": "Several normal appearing nodes are seen in the right axilla with a maximum\ncortical thickness of under 0.3 cm. No adenopathy or abnormal masses are seen.", + "output": "Normal ultrasound of the right axilla.\n\nRECOMMENDATION: Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nThere is no suspicious mass, architectural distortion or suspicious grouped\nmicrocalcifications in the vicinity of the radiopaque marker. \nWell-circumscribed fat containing round 4 mm mass, consistent with fat\nnecrosis is seen adjacent to the radiopaque marker.\n\nBREAST ULTRASOUND: Targeted ultrasound of the area of palpable concern was\nperformed which was without any discrete suspicious solid or cystic masses. \nIncidentally, there are several anechoic well-circumscribed oval masses with\nno internal vascularity, consistent with oil cysts in the 2 o'clock position 9\ncm from the nipple.", + "output": "There are no suspicious mammographic or sonographic findings in the area of\npalpable concern in left breast.\n\nRECOMMENDATION(S): Clinical followup is recommended. Final patient\ndisposition and any decision to biopsy should based on clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nCorresponding to the radiopaque marker in the inner right breast there is a 5\nmm oil cyst, corresponding to the cystic lesion on ultrasound. There is a\npartially imaged right silicone breast implant. There are no suspicious\nmasses on the included images.\n\nBREAST ULTRASOUND: Ultrasound of palpable lumps in both axillary regions was\nperformed. Palpable lump in the right axilla corresponds to a 15 mm\nmorphologically normal-appearing lymph nodes with top-normal cortical\nmeasurement of 2.5 mm. Similarly, in the left axilla the palpable lump felt\nby the patient corresponds to a top-normal lymph node. Ultrasound of the\nareas of pain in both breast was performed. No suspicious solid or cystic\nmasses are seen. Incidentally in the right medial breast there is a 5 mm\nround anechoic circumscribed mass.", + "output": "No suspicious findings in the areas of pain in both breasts. Bilateral\npalpable axillary lymph nodes have top-normal cortical thickness.\n\nRECOMMENDATION(S): Six-month follow up bilateral axillary ultrasound.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Prominent bilateral axillary lymph nodes are noted without significant change.\nCortical thickness measures up to 4 mm on the right.", + "output": "Stable appearance of the prominent bilateral axillary lymph nodes.\n\nRECOMMENDATION(S): Same-day left axillary lymph node FNA was performed.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "The left brachial artery is patent with a velocity of 285 centimeters/second. \nThe anastomosis is patent with a velocity of 903 cm/sec. The left\nbrachiocephalic fistula appears patent with velocities of 371 cm/sec, 154\ncm/sec and 247 cm/sec in the proximal, mid and distal fistula, respectively. \nThe mean flow volume is 1474 cc/minute the fistula measures 0.55 cm in the\nproximal fistula, 0.64 cm in the mid fistula and 0.56 cm in the distal\nfistula.", + "output": "Patent brachiocephalic fistula with elevated velocities at the anastomosis. \nDecreased velocities within the fistula which may be related to a stenosis at\nthe anastomosis.\n\nRECOMMENDATION(S): If further evaluation is desired, a fistulogram may be\nperformed to evaluate for anastomotic stenosis." + }, + { + "input": "The aorta measures 2.5 cm in the proximal portion, 2.5 cm in mid portion and\n2.1 cm in the distal abdominal aorta. There is mild calcified atherosclerotic\nplaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe left common iliac artery measures 1.2 cm. The right common iliac artery\nis poorly visualized.\n\nThe right kidney measures 9.0 cm and the left kidney measures 8.5 cm. Limited\nviews of the kidneys are unremarkable without hydronephrosis. Incidental note\nis made of a 5 mm simple cyst in the midpole of the left kidney.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 50 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 62, 89, and 89 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.8.\nThe external carotid artery has peak systolic velocity of 62 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 84, 77, and 84 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 57 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous plaque bilaterally in the internal carotid arteries without\nsignificant stenosis." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no mammographic abnormality at the site of the patient's pain, as\nindicated by the overlying triangular marker in the upper-outer right breast. \nThere are a few benign-appearing round calcifications in the central inner\nbreast posteriorly. There is no suspicious mass or architectural distortion. \nAxillary breast tissue is noted.\n\nBREAST ULTRASOUND: Targeted ultrasound at the site of the patient's pain, as\nindicated by the patient, at 11 o'clock 11 cm from the nipple and in the\nretroareolar region, demonstrates no sonographic abnormality. There is no\nsolid mass or cystic lesion identified.", + "output": "No mammographic or sonographic abnormality at the site of patient's pain. \nClinical followup is recommended.\n\nRECOMMENDATION(S): Age and risk appropriate mammography. Please note that\nbreast pain should be managed on clinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no mammographic abnormality at the site of the patient's pain, as\nindicated by the overlying triangular marker in the upper-outer right breast. \nThere are a few benign-appearing round calcifications in the central inner\nbreast posteriorly. There is no suspicious mass or architectural distortion. \nAxillary breast tissue is noted.\n\nBREAST ULTRASOUND: Targeted ultrasound at the site of the patient's pain, as\nindicated by the patient, at 11 o'clock 11 cm from the nipple and in the\nretroareolar region, demonstrates no sonographic abnormality. There is no\nsolid mass or cystic lesion identified.", + "output": "No mammographic or sonographic abnormality at the site of patient's pain. \nClinical followup is recommended.\n\nRECOMMENDATION(S): Age and risk appropriate mammography. Please note that\nbreast pain should be managed on clinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 60, 46, and 44 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 59 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 65 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 68, 96, and 62 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 76 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild homogeneous atherosclerotic plaque bilaterally resulting in less than 40%\nstenosis of both ICAs." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 61, 36, and 36 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 18\ncm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 52, 54, and 63 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 23\ncm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 63 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "Correlating with CT abdomen and pelvis images from ___, initially it\nwas decided to biopsy the periumbilical soft tissue nodule. Based on the\nultrasound images, this nodule was hyperechoic, and thus an unusual appearance\nfor a metastatic lesion. 2 core-biopsy samples of this lesion was obtained.\n\nSubsequently correlating with CT abdomen and pelvis images the 1 cm omental\nnodule in the left upper abdomen which was solid, hypoechoic and more\nsuspicious for metastatic lesion and was selected for biopsy. Using\nultrasound guidance 3 core-biopsy samples of left upper quadrant omental\nnodule were obtained.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry sites for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues were anesthetized\nwith 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, five 18-gauge core biopsy passes were\nmade as described in FINDINGS section. The sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was NOT GIVEN.", + "output": "Uncomplicated 18-gauge targeted core-biopsy of the periumbilical soft tissue\nnodule and left upper abdomen omental nodule x 5, with specimens sent to\npathology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n122/36 cm/sec in its proximal portion, 81/22 cm/sec in its mid portion, and\n78/31 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n119/40 cm/sec.\nThe external carotid artery has peak systolic velocity of 107 cm/sec.\nThe vertebral artery has peak systolic velocity of 62 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.0.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n99/23 cm/sec in its proximal portion, 77/33 cm/sec in its mid portion, and\n84/33 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of\n121/31 cm/sec.\nThe external carotid artery has peak systolic velocity of 59 cm/sec.\nThe vertebral artery has peak systolic velocity of 72 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.81.", + "output": "1. No plaque or narrowing identified identified. Normal antegrade flow in the\nbilateral vertebral arteries." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. There are bilateral post surgical changes consistent\nwith known reduction mammoplasty. In the area of concern as indicated by the\npatient in the central lower left breast, there is an asymmetry with multiple\noil cysts and coarse calcifications. The imaging appearance favors fat\nnecrosis. In addition, a similar appearing area is seen in the posterior\ncentral right breast. No clusters of suspicious microcalcification are seen\nin either breast.\n\nUltrasound of the left breast from ___ o'clock 1-8 cm from the nipple in the\narea of concern as indicated by the patient was performed. This identified a\nheterogeneous predominantly echogenic area of fibroglandular tissue which\ncontained at least two small cystic appearing areas measuring 0.8 cm and 1.1\ncm in maximal dimension. Findings are consistent with oil cysts. No\nsuspicious solid lesion is appreciated.\n\nGiven the absence of remote comparisons, continued followup imaging in six\nmonths seems reasonable at this time.", + "output": "Probable fat necrosis in the left breast corresponding the area of concern as\nindicated by the patient. Followup imaging in six months seems reasonable at\nthis time.\n\nRECOMMENDATION: Left diagnostic mammography and left breast ultrasound in six\nmonths.\n\nNOTIFICATION: Via an interpreter, Findings discussed with the patient at the\ntime of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. There are bilateral post surgical changes consistent\nwith known reduction mammoplasty. In the area of concern as indicated by the\npatient in the central lower left breast, there is an asymmetry with multiple\noil cysts and coarse calcifications. The imaging appearance favors fat\nnecrosis. In addition, a similar appearing area is seen in the posterior\ncentral right breast. No clusters of suspicious microcalcification are seen\nin either breast.\n\nUltrasound of the left breast from ___ o'clock 1-8 cm from the nipple in the\narea of concern as indicated by the patient was performed. This identified a\nheterogeneous predominantly echogenic area of fibroglandular tissue which\ncontained at least two small cystic appearing areas measuring 0.8 cm and 1.1\ncm in maximal dimension. Findings are consistent with oil cysts. No\nsuspicious solid lesion is appreciated.\n\nGiven the absence of remote comparisons, continued followup imaging in six\nmonths seems reasonable at this time.", + "output": "Probable fat necrosis in the left breast corresponding the area of concern as\nindicated by the patient. Followup imaging in six months seems reasonable at\nthis time.\n\nRECOMMENDATION: Left diagnostic mammography and left breast ultrasound in six\nmonths.\n\nNOTIFICATION: Via an interpreter, Findings discussed with the patient at the\ntime of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Distended, sludge-filled gallbladder with gallbladder wall edema and\npericholecystic fluid, similar to ultrasound of the previous day. There is a\ntrace amount of perihepatic ascites. Right pleural effusion is noted.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder, with sample sent for microbiology evaluation." + }, + { + "input": "There is a single live intrauterine gestation. The fetus is in cephalic\nposition. The placenta is posterior. Transvaginal examination of the cervix\nwas performed. The cervix appears close measuring 3.3 cm in length. There is\nno evidence of previa however, the inferior edge of the placenta remains\nlow-lying approximately 1.4 cm from the internal os. The amniotic fluid index\nmeasures 19 cm. No fetal morphologic abnormalities are detected. The uterus\nis normal. No adnexal abnormalities are seen.\n\nThe following biometric data were obtained:\n\nBPD 75 mm, 30 weeks 0 days.\nHC 289 mm, 31 weeks 6 days.\nAC 278 mm, 31 weeks 6 days.\nFL 58 mm, 30 weeks 2 days.\n\nAge by US: 31 weeks 0 days.\nAge by Dates: 30 weeks 3 days.\n\nEFW 1715 g, 64% (based on LMP)\n\nCompared to the prior exam there has been appropriate interval growth. A\nbiophysical profile was performed. Two points each were given for fetal\nmovement, tone, practice breathing, and amniotic fluid volume for an overall\nscore 8 out of 8.", + "output": "1. Single live intrauterine gestation in cephalic presentation measuring size\nwithin normal limits for dates. Appropriate interval growth when compared to\nprior ultrasound.\n2. Low-lying placenta with inferior edge of the placenta lying 1.4 cm from the\ninternal os.\n3. Normal biophysical profile score ___.\n4. Amniotic fluid index ___ cm.\n\nNOTIFICATION: The findings were discussed with ___, m.D. by the\nsonographer, via preliminary report on ___ at 9:56 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion, or suspicious grouped\ncalcifications.\n\nLeft breast ultrasound: Targeted ultrasound was performed in the area of\nconcern of the referring clinician at 2 o'clock 1 cm from the nipple as well\nas the upper outer quadrant. No suspicious solid or cystic mass was\nidentified..", + "output": "1. No concerning findings in the left breast in the area of concern. \nClinical follow-up is recommended. Any decision to biopsy should be based on\nclinical assessment.\n2. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Annual screening mammogram\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. The liver is diffusely echogenic.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of 5\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of clear, straw-colored ascitic fluid was removed.\nFluid samples were submitted to the laboratory for cell count, differential,\nhematology, and culture. Another fluid pocket was identified in the right\nlower quadrant and a 5 ___ catheter was advanced into this pocket, removing\nan additional 3 L of amber-colored ascitic fluid.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis yielding a total of 6 L of ascitic fluid from two different\ncatheter approaches. The first approach drained 3 L of clear, straw-colored\nascitic fluid and the second approach drained 3 L of amber-colored ascitic\nfluid. Fluid samples from the first approach were submitted to the laboratory\nfor cell count, differential, hematology and culture." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.3 L of amber colored ascitic fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis yielding 2.3\nL of amber-colored ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.7 L of serosanguinous fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis removing 2.7\nL of serosanguineous ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.5 L of serosanguinous fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Successful ultrasound-guided paracentesis. 4.5 L of serosanguineous ascites\nremoved." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.1 L of clear, amber colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis with removal\nof 4.1 L of clear, amber colored fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 6.1 L of serosanguineous fluid was removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "6.1 L of ascitic fluid was drained from the left lower quadrant via\nultrasound-guided diagnostic and therapeutic paracentesis without\ncomplications." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.76 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.76 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7.8 L of clear straw-colored fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.8 L of amber colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis with removal\nof 4.8 L of amber colored fluid from the left lower quadrant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 5.4 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant. After removal about 5.5 L of straw-colored yellow fluid, the\nflow of fluid had stopped despite repositioning of the patient and the\ncatheter was removed. Another entrance site adjacent to the first site with a\npocket of fluid was selected via ultrasound and 1% lidocaine was instilled for\nlocal anesthesia of the new site and a new 5 ___ catheter was advanced into\nthe largest fluid pocket under ultrasound guidance. A total of 7.1 L of\nclear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7.1 L of fluid in total were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.9 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6 L of clear, straw-colored ascitic fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis yielding 6 L\nof clear, straw-colored ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.2 L of clear, straw-colored fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.4 L of clear, straw-colored fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.7 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.3 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Successful therapeutic right lower quadrant paracentesis\n2. 6.3 L of clear yellow fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 7 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 6.3 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.2 L of pinkish tinged yellow fluid fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.8 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.5 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.9 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.1 L of serosanguinous fluid were removed. During the\ncourse of the procedure the catheter was displaced due to patient movement. A\nsecond 5 ___ catheter was advanced in the largest pocket in the right lower\nquadrant after lidocaine was instilled for local anesthesia.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.9 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.3 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.4 L of serosanguineous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.9 L of clear, red-tinged fluid were removed. Specimens\nsent for requested labs.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.8 L of straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Ultrasound-guided therapeutic paracentesis\n2. 3.8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.2 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.2 L of serosanguineous fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.3 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.3 L of serosanguineous fluid were removed." + }, + { + "input": "The liver is enlarged and heterogeneous in echotexture with enlargement of\nleft lateral segments and also echogenic areas of parenchyma suggesting of\ncoinciding fatty infiltration with known underlying cirrhosis. There is no\nbiliary dilatation. The gallbladder is unremarkable. The pancreas is not\nwell visualized. The spleen is at the upper limits of normal size, measuring\nup to 12.3 cm in length. Moderate ascites is present.\n\nThe main portal vein and its major branches show appropriate hepatopetal flow.\nHepatic venous waveforms are biphasic, which is often seen with cirrhosis, but\nthe hepatic veins are widely patent. Hepatic arterial waveform appears\nnormal.\n\nThere is a fluid-containing umbilical corresponding to recent prior CT\nfindings. With Valsalva, there is transient passage of small bowel part-way\ninto the sac (transient reducible Richter hernia).", + "output": "1. Unremarkable hepatic vasculature.\n\n2. Findings suggestive of acute on chronic liver disease.\n\n3. Moderate ascites.\n\n4. Transient Richter hernia at umbilicus." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 6.25 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Ultrasound-guided therapeutic paracentesis with 6.25 L of ascitic fluid\nremoved without complication." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.5 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated therapeutic paracentesis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5 L of straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis, with\nremoval of 5 L of straw-colored fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 6.3 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis, yielding\n6.3 L of clear, straw-colored ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.8 L of serosanguinous fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound guided therapeutic paracentesis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.7 L of clear, blood-tinged fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis (2.7 L LLQ)." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.9 L of slightly blood-tinged clear fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis (2.9 L from\nRLQ)." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a\nmoderate-to-large amount of ascites. A suitable target in the deepest pocket\nin the right lower quadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 5.5 L of clear, serosanginous fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis (RLQ 5.5 L)." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.3 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis with removal\nof 5.3 L of clear, straw-colored ascites." + }, + { + "input": "Targeted left breast ultrasound again demonstrates a 0.7 x 0.4 x 1 cm\nwell-circumscribed hypoechoic oval mass at 3 o'clock, 4 cm from the nipple\nwithout posterior features or increased vascularity which was targeted for\nultrasound-guided core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ MD (___). The procedure was supervised by ___\n___ MD (___).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement along the inferomedial edge of left breast mass.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted left breast ultrasound again demonstrates a 0.7 x 0.4 x 1 cm\nwell-circumscribed hypoechoic oval mass at 3 o'clock, 4 cm from the nipple\nwithout posterior features or increased vascularity which was targeted for\nultrasound-guided core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ MD (___). The procedure was supervised by ___\n___ MD (___).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement along the inferomedial edge of left breast mass.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are 2 oval circumscribed masses, 1 slightly hyperdense and the other\nisodense to the parenchyma measuring 1.3 x 0.7 cm and 0.8 x 0.4 cm in the\nlateral left breast at the mid nipple line, at anterior-middle depth. There\nare a few scattered benign calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 3 o'clock 4 cm\nfrom the nipple demonstrates an oval macrolobulated hypoechoic mass measuring\n1.3 x 0.8 x 0.9 cm. A few internal septations are noted. This may represent\na macrolobulated fibroadenoma. However, given the patient's age,\nconsideration should be given to biopsy.\nScanning of the left axilla demonstrates normal appearance of several axillary\nlymph nodes without cortical thickening.", + "output": "1.3 cm left breast mass, possibly benign. Given the patient's age and\nbaseline mammogram status, biopsy is recommended for definitive pathology.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy left breast 3 o'clock mass\nwith clip placement.\n\nNOTIFICATION: Findings and recommendation for biopsy reviewed with the\npatient and her daughter. The patient agrees with the plan and she was given\ninformation to set up an appointment, to include an interpreter.\n\n The impression and recommendation above was entered by Dr. ___\n___ on ___ at 14:45 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider with\nrequest for biopsy orders.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in the right breast.\n\nRIGHT BREAST ULTRASOUND:\nTargeted ultrasound exam of the right breast was performed in area of clinical\nconcern spanning 5 to 7 o'clock positions. No discrete cystic or solid mass is\nidentified.", + "output": "No mammographic or sonographic correlate to patient's right breast pain. \nClinical follow up is recommended.\n\nRECOMMENDATION: Further management of the patient should be based on clinical\nassessment at this time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in the right breast.\n\nRIGHT BREAST ULTRASOUND:\nTargeted ultrasound exam of the right breast was performed in area of clinical\nconcern spanning 5 to 7 o'clock positions. No discrete cystic or solid mass is\nidentified.", + "output": "No mammographic or sonographic correlate to patient's right breast pain. \nClinical follow up is recommended.\n\nRECOMMENDATION: Further management of the patient should be based on clinical\nassessment at this time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The uterus is anteverted and measures 6.6 x 5.3 x 3.9 cm. The endometrium is\nhomogenous and measures 4 mm. IUD is identified within the uterine fundus.\n\nThe ovaries are normal. There is no free fluid.", + "output": "Normal uterus and ovaries. IUD is in appropriate position at the uterine\nfundus. No tubo-ovarian abscess identified." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. \nThere were multiple hypoechoic hepatic lesions noted in the right lobe of the\nliver. The lesion targeted for biopsy measured approximately 2.0 x 1.8 cm,\nlocated in segment VIII.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, two 18-gauge core biopsy sample was\nobtained. A sample was provided to the on-site cytologist who indicated an\nadequate sample. A second core was obtained and also given to the on-site\ncytologist.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 37\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimens provided to\nthe cytologist." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications in either breast. The left breast mass is\nnot appreciated on the current mammogram.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast at 6 o'clock 2\ncm from the nipple demonstrates a 1.8 x 0.5 x 1.4 cm oval circumscribed\nhypoechoic mass without dominant vascularity or posterior shadowing. The\nappearance and size are similar to the prior studies.", + "output": "No specific evidence of malignancy.\n___ year stability of the probably benign 1.8 cm left breast mass, likely a\nbenign entity such as a fibroadenoma, lobule of breast tissue or fat lobule. \n1 additional follow-up ultrasound is recommended at this time.\n\nRECOMMENDATION(S): ___ year bilateral diagnostic mammogram and left breast\nultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nRight Breast:\nThere is no other dominant mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. There is no significant change.\nLeft Breast:\nThere is no other dominant mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. There is no significant change.\n\nBREAST ULTRASOUND : Targeted ultrasound left breast was performed. In the\nleft breast at 6 o'clock 2 cm from nipple is a well-circumscribed oval\nhypoechoic mass without any dominant vascularity or posterior shadowing. This\nlikely represents a focal fatty lobule and is stable for ___ years indicating\nbenignity..", + "output": "Stable mass in the left breast at 6 o'clock likely a focal fatty and less\nlikely a fibroadenoma. Given stability for ___ years this indicates benignity. \nNo evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 109 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 74, 72, and 48 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 88 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 114 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 78, 92, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 13 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 136 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild atherosclerotic plaque burden bilaterally with less than 40% stenosis of\nboth carotid arteries.\n\nRECOMMENDATION(S): None." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 62, 32, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.72.\nThe external carotid artery has peak systolic velocity of 114 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 87, 60, and 59 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 92 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No appreciable stenosis in the bilateral internal carotid arteries." + }, + { + "input": "RIGHT:\n\nThe right carotid vasculature has minimal heterogeneous atherosclerotic\nplaque.\n\nThe right common carotid artery had peak systolic/diastolic velocities of\n52/15 cm/sec.\n\nThe right internal carotid artery had peak systolic/diastolic velocities of\n46/14 cm/sec in its proximal portion, 64/15 cm/sec in its mid portion and\n78/20 cm/sec in its distal portion.\n\nThe external carotid artery has peak systolic velocity of 91cm/sec.\n\nThe vertebral artery has peak systolic velocity of 43 cm/sec with normal\nantegrade flow.\n\nThe right ICA/CCA ratio is 1.5.\n\nLEFT:\n\nThe left carotid vasculature has large calcified atherosclerotic plaque in the\nproximal ECA.\n\nThe left common carotid artery had peak systolic/diastolic velocities of 76/17\ncm/sec.\n\nThe left internal carotid artery had peaks ystolic/diastolic velocities of\n54/10 cm/sec in its proximal portion, 61/14 cm/sec in its mid portion and\n78/22 cm/sec in its distal portion.\n\nThe external carotid artery has peak systolic velocity of 192cm/sec.\n\nThe vertebral artery has peak systolic velocity of 51 cm/sec with normal\nantegrade flow.\n\nThe left ICA/CCA ratio is 1.0.", + "output": "Less than 40% right internal carotid and no significant left internal carotid\nstenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 41, 44, and 40 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 0.72.\nThe external carotid artery has peak systolic velocity of 42 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 46, 47, and 33 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.62.\nThe external carotid artery has peak systolic velocity of 44 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No atherosclerotic disease or stenosis of either carotid artery." + }, + { + "input": "Targeted ultrasound of the patient's clinical concern in the right breast at\n10 o'clock 4 cm from the nipple with the patient sitting upright demonstrates\nundulation of the breast implant at the patient's area of clinical concern. \nThe breast parenchyma appears normal and is heterogeneously dense without\nsuspicious solid or cystic mass. With the patient is supine, the area of\nundulation of the breast implant resolves and the area of clinical concern is\nno longer palpable.", + "output": "No specific a evidence of malignancy in the right breast. The area of the\npatient's clinical concern represents undulation of the breast implant.\n\nDue to the ultrasound findings, the scheduled mammogram was canceled.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Multi-septated partly organized fluid with the largest pocket in the right\nlower quadrant.", + "output": "Successful ultrasound-guided placement of an 8 ___ pigtail catheter into\nright lower quadrant markedly septated fluid collection, removing 20 cc\nserosanguineous fluid. A sample of fluid was sent for microbiology evaluation.\nThe catheter was placed to bulb suction." + }, + { + "input": "Reidentified is a 3.0 cm fluid collection inferior to the existing PTBD which\ncollapsed after aspiration.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation." + }, + { + "input": "There is normal respiratory variation in both common femoral veins, an\nindirect indicator of central venous patency.\n\nThere is normal compressibility and augmentation of both common femoral,\nfemoral, popliteal, posterior tibial, peroneal, greater and lesser saphenous\nveins. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis in the lower extremities." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 86, 98, and 76 cm/sec, respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 80 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 145, 212, and 93 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 73 cm/sec.\nThe ICA/CCA ratio is 3.2.\nThe external carotid artery has peak systolic velocity of 118 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate stenosis of the left internal carotid artery (60-69%).\nMild stenosis of the right internal carotid artery (<40%)." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of green-brown fluid were removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.5 L of brownish green fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.25 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to laboratory for chemistry, microbiology in\nHematology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.25 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.2 L of fluid were removed." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nSuspicious irregular microcalcifications are identified in the upper central\nright breast spanning 3 cm. Surrounding architectural distortion is noted. \nNo associated mass is identified.\n\nBREAST ULTRASOUND: Ultrasound evaluation of the upper central right breast\nwas performed. Subtle mixed hyperechoic and hypoechoic nodularity is\nidentified at 12 o'clock, 2-3 cm from the nipple. Punctate echogenic foci are\nidentified in this region.\n\nIn addition, evaluation of the right axilla was performed and no\nlymphadenopathy was detected.", + "output": "Highly suspicious right breast microcalcifications in the 12 o'clock position\nlikely correlating to nodular hypoechoic tissue by ultrasound.\n\nRECOMMENDATION(S): Same day ultrasound guided core biopsy was performed.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. Dr. ___ was informed of these\nresults.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "The area of concern was identified in the upper central right breast.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using two patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___.\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. The marker is a slightly inferior to the majority of the\nmicrocalcifications.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "The area of concern was identified in the upper central right breast.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using two patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___.\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. The marker is a slightly inferior to the majority of the\nmicrocalcifications.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the upper, slightly outer left breast, there is a new, focal asymmetry. \nThere are no associated calcifications. No dominant mass or architectural\ndistortion is identified.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the upper outer left\nbreast, from the 11 o'clock to the 3 o'clock position. The left axilla was\nalso scanned.\n\nAt the 12 o'clock position, approximately 4 cm from the nipple, there is a\nnon-discrete, nodular, hypoechoic region, thought to correlate with the\nmammographic abnormality. This measures 1 x 1 x 0.7 cm.\n\nEvaluation of the left axilla shows normal axillary lymph nodes.", + "output": "Focal asymmetry on mammogram likely corresponds to a hypoechoic nodular region\non ultrasound. Given the patient's history, ultrasound-guided biopsy is\nrecommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the hypoechoic nodular region\nin the upper left breast is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. These results and recommendations were also discussed with ___\n___, NP.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the upper, slightly outer left breast, there is a new, focal asymmetry. \nThere are no associated calcifications. No dominant mass or architectural\ndistortion is identified.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the upper outer left\nbreast, from the 11 o'clock to the 3 o'clock position. The left axilla was\nalso scanned.\n\nAt the 12 o'clock position, approximately 4 cm from the nipple, there is a\nnon-discrete, nodular, hypoechoic region, thought to correlate with the\nmammographic abnormality. This measures 1 x 1 x 0.7 cm.\n\nEvaluation of the left axilla shows normal axillary lymph nodes.", + "output": "Focal asymmetry on mammogram likely corresponds to a hypoechoic nodular region\non ultrasound. Given the patient's history, ultrasound-guided biopsy is\nrecommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the hypoechoic nodular region\nin the upper left breast is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. These results and recommendations were also discussed with ___\n___, NP.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Multiple hypoechoic omental nodules were identified in the right-side of the\nabdomen just above the level of the umbilicus.", + "output": "Technically successful omental biopsy\n\nRECOMMENDATION(S): While patient was in the radiology recovery unit, it was\nnoticed that his blood pressure was high with systolic blood pressure readings\nof over 200 mmHg. He reported that he had taken his blood pressure medication\nthat day. He did not report any pain or discomfort before, during or after\nthe procedure in radiology. Due to his consistently elevated abnormal blood\npressure he was transferred to the emergency department for further\nevaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque at\nthe ICA origin.\nThe peak systolic velocity in the right common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 103, 99, and 96 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 130 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque at\nthe ICA origin.\nThe peak systolic velocity in the left common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 99, 92, and 81 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 119 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis in either carotid artery.\nNormal antegrade flow in both vertebral arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 109, 76, and 90 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 45\ncm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 180 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 30 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 126, 57, and 78 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 25\ncm/sec.\nThe ICA/CCA ratio is 4.2.\nThe external carotid artery has peak systolic velocity of 20 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA 40-59% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 70.2 cm/s / 12.4 cm/s\nCCA Distal: 51.3 cm/s / 10 cm/s\nICA ___: 60.9 cm/s / 13 cm/s\nICA Mid: 84.9 cm/s / 17.9 cm/s\nICA Distal: 77.5 cm/s / 19.1 cm/s\nECA: 95.7 cm/s\nVertebral: 53.4 cm/s\n\nICA/CCA Ratio: 1.65\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate homogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 62.1 cm/s / 14.6 cm/s\nCCA Distal: 58 cm/s / 11.6 cm/s\nICA ___: 212 cm/s / 50.1 cm/s\nICA Mid: 203 cm/s / 43.5 cm/s\nICA Distal: 188 cm/s / 38.5 cm/s\nECA: 137 cm/s\nVertebral: 53 cm/s\n\nICA/CCA Ratio: 3.66\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA 60-69% stenosis." + }, + { + "input": "RIGHT:\nThere is moderate heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 76.2 cm/s / 15.8 cm/s\nCCA Distal: 73.3 cm/s / 22.9 cm/s\nICA ___: 144 cm/s / 33 cm/s\nICA Mid: 186 cm/s / 38 cm/s\nICA Distal: 105 cm/s / 34 cm/s\nECA: 137 cm/s\nVertebral: 85.6 cm/s\n\nICA/CCA Ratio: 2.54\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 81.1 cm/s / 19.8 cm/s\nCCA Distal: 100 cm/s / 25.5 cm/s\nICA ___: 81.7 cm/s / 22.3 cm/s\nICA Mid: 68.9 cm/s / 20.4 cm/s\nICA Distal: 83 cm/s / 29.4 cm/s\nECA: 83.3 cm/s\nVertebral: 58.6 cm/s\n\n\nICA/CCA Ratio: 0.83\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 60-69% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nAdditional imaging demonstrate an ovoid circumscribed mass in the right lower\nslightly inner quadrant without associated calcifications or distortion. This\non same day ultrasound corresponds to a simple cyst.\n\nRIGHT BREAST ULTRASOUND:\n\nThe lower central and lower inner quadrant was scanned. In the 6 o'clock, 3\ncm from the nipple there is an anechoic circumscribed oval mass which measures\n3 mm in maximum ___ and demonstrates good through transmission and no\ninternal vascularity. This is consistent with a simple cyst and corresponds\nto the mass on the mammogram. No solid mass is seen.", + "output": "No evidence of malignancy. Mammographic mass corresponds to a simple cyst on\nultrasound.\n\nRECOMMENDATION: Annual mammography is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque in\nthe right internal and external carotid arteries.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n85/24 cm/sec in its proximal portion, 97/ 29 cm/sec in its mid portion, and\n104/36 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n84/26 cm/sec.\nThe external carotid artery has peak systolic velocity of 128 cm/sec.\nThe vertebral artery has peak systolic velocity of 37 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.2.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque at\nthe takeoff of the internal carotid artery.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n77/20 cm/sec in its proximal portion, 78/20 cm/sec in its mid portion, and\n70/27 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of\n102/18 cm/sec.\nThe external carotid artery has peak systolic velocity of 102 cm/sec.\nThe vertebral artery has peak systolic velocity of 57 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.76.", + "output": "Less than 40% stenosis of the ICAs bilaterally. Mild heterogeneous plaque at\nthe bilateral internal carotid arteries as well as within the takeoff of the\nright external carotid artery" + }, + { + "input": "Right breast: Area of symptomatology as directed by the patient at ___ o'clock\napproximately 6 cm from nipple was scanned with negative results.\n\nLeft breast: We were not able to identify a sonographic correlate for the\nmammographic mass. However at 9 o'clock 5 cm from nipple there was a cyst\nmeasuring 5 x 5 x 9 mm identified.", + "output": "No sonographic explanation for the patient's right breast pain.\n\n Although small cyst was identified in the left breast at 9 o'clock there was\nno definite correlate for the mammographically benign circumscribed mass just\nmedial to the nipple line in the posterior breast. Follow-up is recommended\nmammographically.\n\nRECOMMENDATION(S): Left diagnostic mammogram in 6 months.\n\nClinical evaluation of right breast pain.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThe previous mammographic density of the left breast has resolved. There is\nno suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast is performed in the\n9 o'clock position, 5 cm from the nipple, and shows a similar but smaller\nfinding, now measuring 0.7 cm. The finding is parallel, and centrally\nanechoic, but now with non circumscribed margins. There is through\ntransmission.", + "output": "Probably benign assessment. Decrease in size of a probably benign cyst of the\nleft breast, 9 o'clock position, 5 cm from the nipple, but now with non\ncircumscribed margins. The left mammographic density and the patient's left\nbreast pain has resolved.\n\nRECOMMENDATION(S): Recommend follow-up diagnostic mammogram of the left\nbreast and repeat left breast ultrasound to confirm stability of the probably\nbenign complex cyst of the left breast. At that time, the right breast should\nbe screened.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThe previous mammographic density of the left breast has resolved. There is\nno suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast is performed in the\n9 o'clock position, 5 cm from the nipple, and shows a similar but smaller\nfinding, now measuring 0.7 cm. The finding is parallel, and centrally\nanechoic, but now with non circumscribed margins. There is through\ntransmission.", + "output": "Probably benign assessment. Decrease in size of a probably benign cyst of the\nleft breast, 9 o'clock position, 5 cm from the nipple, but now with non\ncircumscribed margins. The left mammographic density and the patient's left\nbreast pain has resolved.\n\nRECOMMENDATION(S): Recommend follow-up diagnostic mammogram of the left\nbreast and repeat left breast ultrasound to confirm stability of the probably\nbenign complex cyst of the left breast. At that time, the right breast should\nbe screened.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications seen in either breast. The left medial\nbreast partially circumscribed asymmetry seen in ___ is not identified\ntoday.\n\nTargeted ultrasound of the left breast was performed with attention to the\narea of prior sonographic abnormality at 9 o'clock, 5 cm from the nipple. \nToday, there is a 4 x 2 x 3 mm hypoechoic region seen which on real-time\nscanning has the appearance of a complicated cyst. This has progressively\ndecreased in size since ___ at which time it measured 9 x 5 x 5 mm. No\nnew cystic or solid mass is seen.", + "output": "Further decrease in size of left breast cyst seen on ultrasound, consistent\nwith a benign finding. Interval resolution of left medial breast asymmetry\ninitially seen in ___. No specific evidence for malignancy in either\nbreast.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe previously seen focal asymmetry in the upper central left breast becomes\npliable on additional views. There are no suspicious grouped calcifications\nor unexplained areas of distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at ___ o'clock 1-8\ncm from the nipple, corresponding to the area of mammographic asymmetry,\ndemonstrates normal parenchyma without discrete cystic or solid mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe previously seen focal asymmetry in the upper central left breast becomes\npliable on additional views. There are no suspicious grouped calcifications\nor unexplained areas of distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at ___ o'clock 1-8\ncm from the nipple, corresponding to the area of mammographic asymmetry,\ndemonstrates normal parenchyma without discrete cystic or solid mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate, heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 119.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 67, 101, and 96 respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 0.84.\nThe external carotid artery has peak systolic velocity of86.\nThe vertebral artery is patent with antegrade flow, without elevated peak\nsystolic velocity 128 centimeters/second.\n\nLEFT:\nThe left carotid vasculature has mild, heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 140.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 109, 124, and 88 respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 113.\nThe vertebral artery is patent with retrograde flow.", + "output": "< 40% stenosis of the right internal carotid artery.\nElevated velocity of the right vertebral artery consistent with a > 50%\nstenosis.\n\n40-59% stenosis of the left internal carotid artery.\nReversal of flow in the left vertebral artery consistent with subclavian steal\nsyndrome.\n\nWhen compared to ___, the stenosis of the internal carotid arteries\nare less severe on the current study. The left vertebral artery is now\nretrograde and there is elevated velocity in the right vertebral artery.\n\nRECOMMENDATION(S): Consider dedicated imaging Left subclavian artery for a\nstenosis if clinically indicated.\n\nNOTIFICATION: Dr. ___ was paged re the results on ___ at 1702." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\n There is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nBILATERAL BREAST ULTRASOUND:\n\nThe retroareolar region of both breasts was scanned. No solid or cystic mass\nis seen. No abnormal vascularity is seen.", + "output": "No abnormality identified at the sites of clinical concern. No evidence of\nmalignancy.\n\nRECOMMENDATION: Final disposition of symptoms should be based on clinical\ngrounds. Otherwise Age and risk appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: D- The breast tissues are markedly dense which lowers the\nsensitivity of mammography and could conceivably obscure a lesion. There is a\nlarge mass with distortion in the inner central slightly lower left breast\ncorresponding the area of concern as indicated by the patient which was\nfurther evaluated with ultrasound. In addition, there is distortion in the\nslightly upper outer left breast which was also further evaluated with\nultrasound. No clusters of suspicious microcalcification are seen in either\nbreast.\n\nUltrasound of the left breast corresponding the area of concern as indicated\nby the patient at 9 o'clock 2 cm from the nipple identifies a 2.9 x 3.8 x 2.3\ncm irregular hypoechoic heterogeneous mass with ductal extension,\nmicrolobulations, angular margins and echogenic halo. This is highly\nsuspicious for malignancy and biopsy is recommended at this time. In\naddition, at 2 o'clock 4-5 cm from the nipple is identified a 1.1 by 1.0 x 1.0\ncm irregular heterogeneous mass contiguous to a 0.7 x 0.9 x 0.6 cm simple\ncyst. This is also concerning for malignancy and biopsy is recommended at\nthis time.\n\nUltrasound of the left axilla identified at least six abnormally thickened\nlymph nodes, the largest of which measures 1.6 x 1.1 x 1.5 cm with a 0.7 cm\nthickened cortex. Findings are concerning for metastatic disease. \nUltrasound-guided fine-needle aspiration of at least the dominant lymph node\nwould be recommended at this time.", + "output": "Two suspicious masses in the left breast as well as suspicious left axillary\nlymph nodes concerning for metastatic disease. Ultrasound-guided core biopsy\nof both of these masses and ultrasound-guided FNA of the dominant abnormal\nleft axillary node is recommended at this time.\n\nRECOMMENDATION: Left breast ultrasound-guided core biopsy x 2 and left\naxillary fine-needle aspiration.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. \nThe patient was offered biopsy at this time a but would prefer to return later\nthis week. Therefore, the patient was scheduled for ___ to\nundergo the two left breast biopsies and the left axillary fine-needle\naspiration. Results were also communicated directly to Dr. ___ and\nDr. ___ by phone on ___ at 11:50 and 12:00, respectively.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: D- The breast tissues are markedly dense which lowers the\nsensitivity of mammography and could conceivably obscure a lesion. There is a\nlarge mass with distortion in the inner central slightly lower left breast\ncorresponding the area of concern as indicated by the patient which was\nfurther evaluated with ultrasound. In addition, there is distortion in the\nslightly upper outer left breast which was also further evaluated with\nultrasound. No clusters of suspicious microcalcification are seen in either\nbreast.\n\nUltrasound of the left breast corresponding the area of concern as indicated\nby the patient at 9 o'clock 2 cm from the nipple identifies a 2.9 x 3.8 x 2.3\ncm irregular hypoechoic heterogeneous mass with ductal extension,\nmicrolobulations, angular margins and echogenic halo. This is highly\nsuspicious for malignancy and biopsy is recommended at this time. In\naddition, at 2 o'clock 4-5 cm from the nipple is identified a 1.1 by 1.0 x 1.0\ncm irregular heterogeneous mass contiguous to a 0.7 x 0.9 x 0.6 cm simple\ncyst. This is also concerning for malignancy and biopsy is recommended at\nthis time.\n\nUltrasound of the left axilla identified at least six abnormally thickened\nlymph nodes, the largest of which measures 1.6 x 1.1 x 1.5 cm with a 0.7 cm\nthickened cortex. Findings are concerning for metastatic disease. \nUltrasound-guided fine-needle aspiration of at least the dominant lymph node\nwould be recommended at this time.", + "output": "Two suspicious masses in the left breast as well as suspicious left axillary\nlymph nodes concerning for metastatic disease. Ultrasound-guided core biopsy\nof both of these masses and ultrasound-guided FNA of the dominant abnormal\nleft axillary node is recommended at this time.\n\nRECOMMENDATION: Left breast ultrasound-guided core biopsy x 2 and left\naxillary fine-needle aspiration.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. \nThe patient was offered biopsy at this time a but would prefer to return later\nthis week. Therefore, the patient was scheduled for ___ to\nundergo the two left breast biopsies and the left axillary fine-needle\naspiration. Results were also communicated directly to Dr. ___ and\nDr. ___ by phone on ___ at 11:50 and 12:00, respectively.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Distended, thick-walled gallbladder with sludge.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "Grayscale and Doppler sonograms of the right common femoral, superficial\nfemoral, and popliteal veins show no evidence of deep vein thrombosis. Paired\npatent posterior tibial and peroneal veins are identified.\n\nMost of the course of the greater saphenous vein shows occlusive thrombosis,\nprobably an acute finding. The occlusive component of the clot lies within\njust about 3 cm femoral junction although non-occlusive components of thrombus\nextend more proximally, up to about 1 cm.", + "output": "Superficial thrombophlebitis, extensive along the course of the greater\nsaphenous vein, including close approach to the saphenofemoral junction; no\nevidence of deep vein thrombosis, however." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nchest wall in the region of the patient's palpable abnormality was performed. \nReidentified is the 2.0 x 1.0 x 2.3 cm oval circumscribed hypoechoic mass with\ninternal vascularity.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues were anesthetized\nwith 10 mL 1% lidocaine. Under real-time ultrasound guidance, an 18 gauge\ncore biopsy needle was then advanced into the lesion and a single core biopsy\nsample was obtained and evaluated by cytology which deemed the sample\nadequate. A second sample was then obtained and placed directly into\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was not performed.", + "output": "Technically successful ultrasound-guided core needle biopsy of an enlarged\nlymph node on the right chest wall near the axilla. The specimen was\nevaluated by on-site cytology which deemed the sample adequate." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThere is a 5-mm, circumscribed mass in the right inner slightly lower breast\nthat persists on spot compression views. There is no dominant mass in the left\nbreast, including in the region in the left medial lower breast of the\npalpable lump reported by the patient that is denoted by a BB marker. There is\nno architectural distortion or suspicious grouped microcalcification in either\nbreast.\n\nTARGETED BREAST ULTRASOUND:\nThere is a 5-mm, anechoic, thin-walled structure without through transmission\nand no internal vascularity in the right breast at 4:00, 4 cm from the nipple,\nwhich corresponds to the mass identified on the mammography. No discrete\nsuspicious solid or cystic mass was identified on targeted ultrasound of the\nleft medial lower breast where the patient feels a lump.", + "output": "1. No mammographic evidence of malignancy.\n\n2. 5-mm cyst in the right lower inner breast .\n\n3. No mammographic or sonographic correlate for the palpable lump reported by\nthe patient in the left medial lower breast.\n\nRECOMMENDATION(S): Age and risk-appropriate imaging.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of 55\ncm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n63/25 cm/sec in its proximal portion, 45/18 cm/sec in its mid portion and\n47/24 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 62cm/sec.\nThe vertebral artery has peak systolic velocity of 32 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.1..\n\nLEFT:\nThe leftcarotid vasculature has no atherosclerotic plaque.\nThe left common carotid artery had peak systolic/diastolic velocities of 54\ncm/sec.\nThe left internal carotid artery had peaks ystolic/diastolic velocities of\n42/14 cm/sec in its proximal portion, 40/18 cm/sec in its mid portion and\n39/21 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 60cm/sec.\nThe vertebral artery has peak systolic velocity of 19 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.8.", + "output": "Normal bilateral carotid arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 97 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 96, 138, and 96 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 112 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque. Patent left\nICA/CCA stent.\nThe peak systolic velocity in the left common carotid artery is 94 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 109, 91, and 107 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 112 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral carotid systems.\n\nPatent left CCA/ICA stent." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 104 cm/s / 24.7 cm/s\nCCA Distal: 94.3 cm/s / 22.7 cm/s\nICA ___: 70.2 cm/s / 22.1 cm/s\nICA Mid: 108 cm/s / 31.4 cm/s\nICA Distal: 79.2 cm/s / 22.5 cm/s\nECA: 91.2 cm/s /\nVertebral: 52.2 cm/s /\n\nICA/CCA Ratio: 1.15\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is no atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 62.9 cm/s / 22 cm/s\nCCA Distal: 84.9 cm/s / 24.1 cm/s\nICA ___: 88.1 cm/s / 20.4 cm/s\nICA Mid: 54.5 cm/s / 17.8 cm/s\nICA Distal: 68.7 cm/s / 23.1 cm/s\nECA: 69.2 cm/s /\nVertebral: 35.6 cm/s / 18.3 cm/s\n\n\nICA/CCA Ratio: 1.04\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.\nPatent left ICA/CCA stent.", + "output": "Right ICA <40% stenosis.\nLeft ICA no stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 56 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 83 cm/s, 89 cm/s, and 76 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of60 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 64 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 71 cm/s, 59 cm/s, and 66 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 149 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis in either internal carotid artery of\nless than 40%." + }, + { + "input": "Pre-procedure sonographic images demonstrate an enlarged 3.6 x 2.0 cm right\ninguinal lymph node with multiple adjacent enlarged lymph nodes. Multiple\nintra procedure images demonstrate the biopsy device to be within the lymph\nnode.", + "output": "Technically successful ultrasound-guided core biopsy of a right inguinal lymph\nnode. Samples were sent to pathology for review." + }, + { + "input": "Grayscale, color, and spectral doppler imaging was obtained of the right and\nleft common femoral, femoral, and popliteal veins. Normal flow,\ncompressibility, augmentation, and waveforms are demonstrated. No intraluminal\nthrombus is identified. Normal color flow and compressibility are demonstrated\nin the posterior tibial and peroneal veins. There is normal respiratory\nvariation in both common femoral veins. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis in right or left lower extremity." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 96 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 88 cm/s, 84 cm/s, and 76 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of96 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 86 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 68 cm/s, 77 cm/s, and 73 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 73 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA less than 40% stenosis. Left ICA no stenosis." + }, + { + "input": "RIGHT:\nModerate calcified plaque is seen in the right common carotid artery, in the\nright carotid bulb and at the origin of the right ICA.\nThe peak systolic velocity in the right common carotid artery is 107 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 133, 89, and 106 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.24.\nThe external carotid artery has peak systolic velocity of 162 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nModerate calcified plaque is seen in the left carotid bulb and at the origin\nof the left ICA.\nThe peak systolic velocity in the left common carotid artery is 97 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 113, 151, and 113 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.56.\nThe external carotid artery has peak systolic velocity of 209 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate stenosis (40-59%) seen bilaterally in the internal carotid arteries." + }, + { + "input": "RIGHT:\n\nThe right carotid vasculature demonstrates presence of moderate\natherosclerotic plaque at the level of the distal CCA, carotid bulb, and\norigin of the right ICA.\nThe peak systolic velocity in the right common carotid artery is 94 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 119 cm/s, 72 cm/s, and 125 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26.3 ___\nThe ICA/CCA ratio is 1.33.\nThe external carotid artery has peak systolic velocity of117 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\n\nThe left carotid vasculature similarly demonstrates moderate atherosclerotic\nplaque at the distal CCA, carotid bulb, and origin of the left ICA.\nThe peak systolic velocity in the left common carotid artery is 77 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 114 cm/s, 141 cm/s, and 168 cm/s respectively. The peak\nend diastolic velocity in the left internal carotid artery is 32.3 cm/sec.\nThe ICA/CCA ratio is 1.71.\nThe external carotid artery has peak systolic velocity of 170 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate stenosis of the internal carotid arteries (40-59%). No significant\nchange from the carotid ultrasound performed in ___." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 56 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 65, 68, and 90 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 63 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 59, 59, and 43 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 52 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 50% stenosis of the right and left internal carotid arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 89 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 70, 70, and 63 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 17 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 68 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 102 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 64, 69, and 74 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 194 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "< 40% stenosis of the right internal carotid artery.\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "The aorta measures 2.0 cm in mid portion and 1.9 cm in the distal abdominal\naorta. The proximal aorta could not be clearly visualized due to overlying\nbowel gas. No aneurysm is visualized.\n\nWall-to-wall color flow is seen within aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.8 cm and the left common iliac artery\nmeasures 0.7 cm.\n\nThe right kidney measures 11.2 cm and the left kidney measures 11.7 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "Somewhat limited visualization of the aorta however no evidence of abdominal\naortic aneurysm." + }, + { + "input": "Heterogeneous fibroglandular tissue is seen with no mass or shadowing\nabnormality.", + "output": "Normal right breast ultrasound.\n\nRECOMMENDATION: Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 69, 75, and 80 seconds cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 89 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 60, 55, and 44 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.71.\nThe external carotid artery has peak systolic velocity of 67 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the bilateral carotid artery." + }, + { + "input": "There was demonstration of a 6.5 x 9.2 x 7.7 cm right axillary collection with\nmultiple internal septations consistent with a lymphocele.", + "output": "Successful US-guided drainage of the right axillary fluid collection as\ndetailed above. Samples were sent for microbiology evaluation." + }, + { + "input": "Re- identified in the right axilla, there is a 2.4 x 3.8 cm hypoechoic fluid\ncollection which was targeted for aspiration.", + "output": "Successful US-guided aspiration of right axillary fluid collection. Samples\nwere sent for microbiology evaluation." + }, + { + "input": "In the right axilla, corresponding to the area of clinical concern and site of\nprior drained fluid collection, there is a 3.4 x 3 x 2.7-cm hypoechoic, thick\nwalled structure without internal vascularity, consistent with a fluid\ncollection. A drain was placed in this fluid collection and confirmed to be\nin place. Post-procedure images demonstrate collapse of the fluid collection\nafter aspiration.", + "output": "Successful US-guided placement of ___ pigtail catheter into the right\naxillary collection.\n\nRECOMMENDATION(S): Post-procedure orders have been placed in POE.\n\nNOTIFICATION: The findings and impression were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:55 ___, 10 minutes\nafter discovery of the findings." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nPreviously described focal asymmetry in the upper, central to slightly outer\nleft breast does not persist on the spot compression views, and is felt to\nrepresent superimposition of benign fibroglandular tissue. However, this area\nwas further evaluated with targeted ultrasound. There is no suspicious mass,\nunexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the upper outer left\nbreast, in the area of mammographic abnormality, which was without any\ndiscrete suspicious solid or cystic masses.", + "output": "1. No specific mammographic or sonographic evidence of malignancy in the left\nbreast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Large hypoechoic mass underlying the deltoid musculature with peripheral\nvascularity, which is better evaluated on the MR from outside hospital dated\n___.", + "output": "Technically successful ultrasound-guided core biopsy of the left shoulder mass\nusing an anterolateral approach with approximately 10 core biopsy specimens\nobtained and sent to cytology, pathology, and microbiology." + }, + { + "input": "Targeted sonographic examination of the area of clinical concern was\nperformed. Patient reports tenderness at ___ o'clock, 9-10 cm from the\nnipple, in the area of reduction scar. Within the dermis in the area of\nclinical concern there is a hypoechoic oblong area measuring 3.2 x 0.4 x 1.4\ncm. This appears to be located within the dermis and does not extend into the\nbreast. Although this area is very hypoechoic, it contains internal\nvascularity on Doppler exam suggesting that it is inflammatory/infectious\ntissue rather than fluid. No drainable fluid collection is present.", + "output": "Recurrence of intradermal infectious/inflammatory process, similar in\nappearance to ___. No drainable fluid collection identified.\n\nRECOMMENDATION(S): Clinical follow-up and imaging follow-up as clinically\nwarranted. Patient has an appointment with ___, NP, from the\nBreastCare Center, later today.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy with an interpreter.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound 6 o'clock left breast 8 cm from the nipple performed\ncovering area of pain is redness demonstrating skin thickening with 2.6 x 1.8\nx 0.3 cm with increased vascularity. There is no communication with the\ndeeper soft tissues. Appearance is similar to prior right breast ultrasound\nfrom ___ been most likely represents infectious/inflammatory process\nconsistent with cellulitis given patient's clinical history. No drainable\nfluid collection/abscess identified.", + "output": "Sonographic findings consistent with cellulitis without drainable fluid\ncollection identified.\n\nRECOMMENDATION(S): Clinical follow-up is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy with the aid of a ___ interpreter.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 48, 73, and 42 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 58 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 56, 60, and 47 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 10.\nThe external carotid artery has peak systolic velocity of 59 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No atherosclerotic plaque or hemodynamically significant stenosis within the\ncarotid vasculature, bilaterally." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of serosanguinous fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.1 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 3.7 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4.7 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket. Cytology kits were used rather than wall suction.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 3.85 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "-Technically successful ultrasound guided therapeutic paracentesis.\n-3.85 L of fluid were removed." + }, + { + "input": "RIGHT:\nThe right internal carotid artery has moderate heterogeneous atherosclerotic\nplaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n141/31 cm/sec in its proximal portion, 95/20 cm/sec in its mid portion, and\n75/17 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n96/19 cm/sec.\nThe external carotid artery has peak systolic velocity of 182 cm/sec.\nThe vertebral artery has peak systolic velocity of 57 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.5.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous plaque atherosclerotic\nplaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n93/20 sec cm/sec in its proximal portion, 100/31 cm/sec in its mid portion,\nand 94/28 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 74/18\ncm/sec.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery has peak systolic velocity of 86 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.4.", + "output": "1. Moderate heterogeneous plaque at the takeoff of the right internal carotid\nartery; mild heterogeneous plaque on the left. 40-59% stenosis on the right\nand less than 40% stenosis on the left." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no suspicious mass, suspicious grouped microcalcifications or\narchitectural distortion.\n\nBREAST ULTRASOUND: Ultrasound was performed in the areas of pain as indicated\nby the patient ___ o'clock 1-8 cm from the nipple. No suspicious solid or\ncystic mass was identified", + "output": "1. No suspicious findings in the area of concern as indicated by the patient. \nClinical follow-up is recommended.\n2. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Follow-up. Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of clear, straw-colored ascitic fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis, yielding 3\nL of clear, straw-colored ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated\nsmall volume of right pleural fluid. A suitable target in the deepest pocket\nin the right posterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 450 mL of clear, yellow/brown fluid was\nremoved. Fluid samples were submitted to the laboratory for chemistry,\nHematology, microbiology and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Successful ultrasound-guided diagnostic thoracentesis of a small right\npleural effusion.\n2. Fluid samples were submitted for chemistry, hematology, microbiology and\ncytology." + }, + { + "input": "The bladder is normal prior to voiding. There are no masses, stones or debris\nnoted within the bladder. There is no thickening of the bladder wall.\n\nThe prevoid volume of the bladder was 743 cc. There is a 42.8 cc post void\nresidual.\n\nIncidentally seen uterine fibroids.", + "output": "Normal sonographic appearance of the bladder with postvoid residual volume of\n42.8 cc." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\nAdditional views of the left breast demonstrates no dominant mass,\narchitectural distortion or suspicious grouped microcalcifications to\ncorrelate with previous mammographic abnormality from ___.\n\nLEFT BREAST ULTRASOUND: There is a 0.3 x 0.3 x 0.1 cm benign appearing simple\ncyst at 11 o'clock position, 2 cm from the nipple, which could correlate with\narea of asymmetry described on prior mammogram from ___. No other\nsonographic abnormality seen in", + "output": "No evidence of malignancy\n\nRECOMMENDATION: Return to screening mammogram in ___ year is recommended\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 26, 29, and 29 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 9\ncm/sec.\nThe ICA/CCA ratio is 0.45.\nThe external carotid artery has peak systolic velocity of 42 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 42 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 42, 39, and 51 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 21\ncm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 56 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA<40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Within the left groin is a 9.2 x 2.5 x 4.7 cm heterogeneously hypoechoic,\navascular lesion within the anterior abdominal wall. This collection is\nanterior to the left common and external iliac arteries. No connection with\nvasculature.\n\nTargeted left groin ultrasound demonstrates normal vessels. No\npseudoaneurysm. Normal arterial and venous waveforms without evidence of AV\nfistula.", + "output": "1. Large 9.2 cm hematoma within the lower left anterior abdominal wall,\nsimilar in appearance to ___ CT.\n2. No pseudoaneurysm." + }, + { + "input": "Informed written consent was obtained. Timeout with double patient\nidentifiers was performed. The previous imaging was reviewed and the lesion\nin the left lobe of the liver in segment IV-B was identified. Using\nultrasound guidance, aseptic technique, and local anesthetic, one 18 gauge\ncore biopsy of the mass lesion was performed. The procedure was well\ntolerated. The attending, Dr. ___, was present and actively participated\nthroughout the procedure. Onsite cytology confirmed adequacy of the sample.\nModerate sedation was provided by administering divided doses of 2 mg of\nVersed in 100 mcg of fentanyl throughout the total intraservice time of\napproximately 20 minutes during which the patient's hemodynamic parameters\nwere continuously monitored.", + "output": "Status post successful targeted biopsy of liver lesion in left\nlobe of liver." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 98 cm/s / 26 cm/s\nCCA Distal: 79 cm/s / 24 cm/s\nICA ___: 94 cm/s / 32 cm/s\nICA Mid: 107 cm/s / 48 cm/s\nICA Distal: 92 cm/s /\nECA: 131 cm/s\nVertebral: 84 cm/s\n\nICA/CCA Ratio: 1.4\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is occlusive heterogeneous atherosclerotic plaque in the left common\ncarotid artery.\nThe left external carotid has retrograde flow filling a patent internal\ncarotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 0 cm/s /\nCCA Distal: 0 cm/s /\nICA ___: 92 cm/s / 15 cm/s,23 cm/s\nICA Mid: 70 cm/s /\nICA Distal: 47 cm/s / 17 cm/s\nECA: 205 cm/s\nVertebral: 71 cm/s\n\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA has less than 40% stenosis.\nOccluded left common carotid artery. The left internal carotid artery is\npatent and fills via retrograde flow coming from the external carotid artery." + }, + { + "input": "Targeted breast ultrasound was performed in the area of palpable abnormality,\nin the left breast, at the ___ position, 3 cm from the nipple. In this\nregion, there is a 2.0 x 1.3 x 2.0 cm well-circumscribed, anechoic structure\nwith through transmission and no demonstrable internal vascularity, consistent\nwith a simple cyst.", + "output": "2.0 x 1.3 x 2.0 cm simple cyst in the left breast, corresponding to the\npalpable area of concern. Aspiration could be considered if desired for\nsymptom relief.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\n2 core biopsy samples were obtained and placed in formalin. The skin was then\ncleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n10 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously seen 3 mm mass in the right inner central breast is not clearly\nseen on the CC or MLO spot compression views. A nodular asymmetry in the\ncentral right breast at mid depth on the lateral view may represent the same\nfinding.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the expected\nlocation of the mammographic findings from ___ o'clock. At 2 o'clock 4 cm\nfrom the nipple, there are 2 nodules located 1 cm apart with parallel\norientation and no prominent vascularity or posterior features. The are\nhypoechoic with hyperechoic rims measuring 0.6 x 0.4 x 0.3 cm and 0.5 x 0.4 x\n0.2 cm. One of these may correspond to the mammographic finding.", + "output": "2 probably benign nodules in the right breast, 1 of which may correspond to\nthe mammographic finding.\n\nRECOMMENDATION(S): Followup diagnostic mammogram and right breast ultrasound\nin 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously seen 3 mm mass in the right inner central breast is not clearly\nseen on the CC or MLO spot compression views. A nodular asymmetry in the\ncentral right breast at mid depth on the lateral view may represent the same\nfinding.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the expected\nlocation of the mammographic findings from ___ o'clock. At 2 o'clock 4 cm\nfrom the nipple, there are 2 nodules located 1 cm apart with parallel\norientation and no prominent vascularity or posterior features. The are\nhypoechoic with hyperechoic rims measuring 0.6 x 0.4 x 0.3 cm and 0.5 x 0.4 x\n0.2 cm. One of these may correspond to the mammographic finding.", + "output": "2 probably benign nodules in the right breast, 1 of which may correspond to\nthe mammographic finding.\n\nRECOMMENDATION(S): Followup diagnostic mammogram and right breast ultrasound\nin 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is interval resolution of medial right breast mass since the prior\nstudy. There is no suspicious mass, architectural distortion or grouped\nmicrocalcification.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at the 2 o'clock\nposition of the right breast 4 cm from the nipple which was without any\ndiscrete suspicious solid or cystic masses.", + "output": "Interval resolution of right breast mass and sonographic abnormalities, which\nmay have represented resolving cysts or hematoma. No specific mammographic or\nsonographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Annual screening mammogram in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "There is normal compressibility, flow, and augmentation of the right common\nfemoral, femoral, and popliteal veins. Normal color flow and compressibility\nare demonstrated in the posterior tibial veins. Normal color flow is\ndemonstrated in the renal veins.\n\nThere is normal respiratory variation in the common femoral veins bilaterally.\n\nNo evidence of medial popliteal fossa (___) cyst.", + "output": "No evidence of deep venous thrombosis in the right lower extremity veins." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe area of prior asymmetry is not visualized on the current repeat views\nincluding 3D tomosynthesis slices. This may have represented overlapping\nglandular tissue or possibly a resolved cyst. Otherwise the right breast is\nremarkable for scattered benign-appearing calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right medial breast was\nperformed from 1 o'clock through 5 o'clock demonstrating normal\nheterogeneously dense glandular tissue without underlying suspicious solid or\ncystic mass.", + "output": "No specific evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe area of prior asymmetry is not visualized on the current repeat views\nincluding 3D tomosynthesis slices. This may have represented overlapping\nglandular tissue or possibly a resolved cyst. Otherwise the right breast is\nremarkable for scattered benign-appearing calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right medial breast was\nperformed from 1 o'clock through 5 o'clock demonstrating normal\nheterogeneously dense glandular tissue without underlying suspicious solid or\ncystic mass.", + "output": "No specific evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the right breast was performed in the area of\nmammographic mass. At the 4 o'clock position 8-10 cm from the nipple, there\nis an oval circumscribed mass within the skin with tract to the skin surface\nand mixed internal echoes including hypoechoic and hyperechoic echoes,\nmeasuring 3 x 3 x 3 mm, consistent with sebaceous cyst. No suspicious solid\nor cystic mass.", + "output": "Right breast sebaceous cyst is benign. Any decision for further intervention\nshould be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up, age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted sonographic examination of the right lower inner breast was performed\nwith attention to the area of clinical concern. At 4 o'clock, 10 cm from the\nnipple, there is a 3 x 4 x 5 mm hypoechoic mass within the dermis with tract\nextending to the skin surface. There are mixed internal echoes. Appearances\nare consistent with known sebaceous cyst. There is little change from ___ allowing for technical differences. No suspicious cystic or solid mass\nis seen in the underlying breast tissue.", + "output": "Right breast sebaceous cyst, which is benign.\n\nRECOMMENDATION(S): Clinical follow-up for any persistent clinical findings. \nAge and risk appropriate screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She states she has an appointment with the Breast Care Center.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: Scattered benign appearing calcifications are seen in both\nbreasts with a more discrete group in the central upper right breast\nmagnification views were performed of these calcifications to determine\nstability. On magnification views, this group has a similar appearance to\nprior exams and is benign. There is no suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nLeft breast: There is no suspicious dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast was performed in\nthe region of the previously imaged sebaceous cyst. Superficially in the\nright breast at 4 o'clock 10 cm from the nipple, there is a 0.8 x 0.7 x 0.9 cm\nround circumscribed dermal based avascular mass which contains anechoic fluid\nas well as echogenic internal debris consistent with a sebaceous cyst. This\nis larger than on the prior examination at which point it measured 0.5 x 0.5 x\n0.4 cm.", + "output": "1. No mammographic evidence of malignancy.\n2. Right breast sebaceous cyst, increased in size. Finding is consistent with\na benign process, however clinical follow-up is recommended if patient decides\nto have the cyst drained.\n\nRECOMMENDATION(S): Clinical follow-up for right breast sebaceous cyst.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "1. Small anterior abdominal fluid collection consistent with findings on the\nprior CT.\n2. Aspiration of approximately 3 cc of serous fluid from the abdominal\ncollection.\n3. Successful placement of an 8 ___ pigtail catheter into the collection.", + "output": "Successful ultrasound-guided placement of an ___ pigtail catheter into\nthe collection. Samples were sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 72 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 69 cm/s, 78 cm/s, and 97 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of127 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 65 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 44 cm/s, 68 cm/s, and 79 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 94 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 81 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 60, 70, and 71 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.87.\nThe external carotid artery has peak systolic velocity of 58 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 72 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 44, 90, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 40 cm/sec.\nThe ICA/CCA ratio is 1.25.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No stenosis in the bilateral carotid arteries." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: There are scattered areas of fibroglandular density.\n There is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications. No abnormalities seen in the right breast at the\nsite of clinical concern.\n\nRIGHT BREAST ULTRASOUND:\n\nThe right axilla and right upper outer quadrant was scanned. No solid or\ncystic mass is seen. No abnormal vascularity seen.", + "output": "No evidence of malignancy. No abnormality identified at the site of clinical\nconcern.\n\nRECOMMENDATION: Final disposition of patient's pain should be based on\nclinical grounds. Otherwise annual screening mammography is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: There are scattered areas of fibroglandular density.\n There is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications. No abnormalities seen in the right breast at the\nsite of clinical concern.\n\nRIGHT BREAST ULTRASOUND:\n\nThe right axilla and right upper outer quadrant was scanned. No solid or\ncystic mass is seen. No abnormal vascularity seen.", + "output": "No evidence of malignancy. No abnormality identified at the site of clinical\nconcern.\n\nRECOMMENDATION: Final disposition of patient's pain should be based on\nclinical grounds. Otherwise annual screening mammography is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nA well-circumscribed 1 cm mass is noted in the right retroareolar region. The\nasymmetry in the left slightly lateral breast is pliable on spot compression\nviews consistent with summation of shadows.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right retroareolar region was\nperformed. In the right breast at 9 o'clock 1 cm from the nipple is a 0.6 x\n0.8 x 1 cm cyst with floating debris. This corresponds to the mass in the\nright retroareolar region seen on mammography.", + "output": "Mass in the right retroareolar region is consistent with a cyst with floating\ndebris. No evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nBreast parenchyma is heterogeneously dense with a diffusely nodular pattern. \nThere is no discrete mass or area of architectural distortion. Scattered\nfaint punctate calcifications are noted. There are no suspicious grouped\nmicrocalcifications.\n\nWithin the left breast, there are calcifications within the upper outer\nbreast, some of which layer on the lateral view compatible with milk of\ncalcium. There is no mass or area of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound in the area of concern as indicated by\nthe patient in the right upper outer breast was performed. At the 10:00\nposition approximately 7-8 cm from the nipple is a 2.1 x 3.1 x 0.9 cm area of\nheterogeneously hypoechoic tissue without discrete borders or internal\nvascularly.", + "output": "1. Ill-defined hypoechoic area corresponding to the palpable abnormality in\nthe right breast for which ultrasound-guided core biopsy is recommended.\n\n2. calcifications in the upper outer left breast, many of which layer, are\nprobably benign, warrant follow up in 6 months time.\n\nRECOMMENDATION(S): Recommend ultrasound guided biopsy of right breast\nsonographic abnormality.\n\nDiagnostic mammogram of the left breast is advised in 6 months time to ensure\nstability of left upper outer quadrant calcifications.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Patient is aware of the need for biopsy and 6 month follow up\nexamination. Our coordinator will call her to schedule times.\n\nThe impression and recommendation above was entered by Dr. ___ on\n___ at 16:43 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider. Specifically,\nordering provider must place an order for the biopsy.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Pre-procedure imaging re-identified a heterogeneously hypoechoic area in the\nright breast at 10 o'clock 8 cm from the nipple measuring 2.4 x 0.9 x 2 cm,\nwhich was targeted for ultrasound-guided core needle biopsy with clip\nplacement.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "1. Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n2. Previously seen mammographic left breast calcifications, for which\nfollow-up is recommended in 6 months as per recommendations from the prior\ndiagnostic mammogram dated ___.\n\nThe patient expects to hear the pathology results from the referring provider,\nDr. ___, in ___ business days. Standard post care instructions\nwere provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Pre-procedure imaging re-identified a heterogeneously hypoechoic area in the\nright breast at 10 o'clock 8 cm from the nipple measuring 2.4 x 0.9 x 2 cm,\nwhich was targeted for ultrasound-guided core needle biopsy with clip\nplacement.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "1. Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n2. Previously seen mammographic left breast calcifications, for which\nfollow-up is recommended in 6 months as per recommendations from the prior\ndiagnostic mammogram dated ___.\n\nThe patient expects to hear the pathology results from the referring provider,\nDr. ___, in ___ business days. Standard post care instructions\nwere provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nLEFT BREAST: Innumerable loosely grouped calcifications are again seen in the\nleft upper outer quadrant, some of which appear to layer on lateral\nprojection, spanning at least 7.7 cm. Asymmetric increased tissue density in\nthe left slightly outer central breast at anterior to mid depth was further\nevaluated with same day left breast ultrasound were a small cyst was\nidentified.\n\nRIGHT BREAST: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. There is a ribbon clip seen in the\nright upper outer quadrant at posterior depth from prior benign biopsy. There\nis a probable subcentimeter calcifying fibroadenoma in the right medial\ninferior breast with a small calcification seen.\n\nLEFT BREAST ULTRASOUND: Targeted left breast ultrasound in the ___\nposition was performed. Multiple tiny anechoic masses are identified,\nconsistent with simple cysts. The largest measures 0.5 x 0.3 x 0.6 cm at the\n___ position 6 cm from the nipple. No suspicious solid or cystic mass is\nidentified.", + "output": "1. ___ year and 6 month stability of probable benign left breast calcifications.\nFollow-up ___ year with bilateral diagnostic mammogram and left breast\nmagnification views is recommended.\n2. Otherwise, no specific evidence of malignancy.\n\nRECOMMENDATION(S): Follow-up ___ year bilateral diagnostic mammogram with\nmagnification views of the left breast calcifications.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nLEFT BREAST: Innumerable loosely grouped calcifications are again seen in the\nleft upper outer quadrant, some of which appear to layer on lateral\nprojection, spanning at least 7.7 cm. Asymmetric increased tissue density in\nthe left slightly outer central breast at anterior to mid depth was further\nevaluated with same day left breast ultrasound were a small cyst was\nidentified.\n\nRIGHT BREAST: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. There is a ribbon clip seen in the\nright upper outer quadrant at posterior depth from prior benign biopsy. There\nis a probable subcentimeter calcifying fibroadenoma in the right medial\ninferior breast with a small calcification seen.\n\nLEFT BREAST ULTRASOUND: Targeted left breast ultrasound in the ___\nposition was performed. Multiple tiny anechoic masses are identified,\nconsistent with simple cysts. The largest measures 0.5 x 0.3 x 0.6 cm at the\n___ position 6 cm from the nipple. No suspicious solid or cystic mass is\nidentified.", + "output": "1. ___ year and 6 month stability of probable benign left breast calcifications.\nFollow-up ___ year with bilateral diagnostic mammogram and left breast\nmagnification views is recommended.\n2. Otherwise, no specific evidence of malignancy.\n\nRECOMMENDATION(S): Follow-up ___ year bilateral diagnostic mammogram with\nmagnification views of the left breast calcifications.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Scans were performed through a sterile water bath instilled into the lumbar\nlaminectomy site, imaging the spinal canal through the intact dura. These\nscans demonstrated an intradural solid heterogeneous mass measuring 1.3 x 1.3\nx 1.8 cm and showing moderate vascularity on color flow Doppler. Several\nnerve roots show displacement dorsally over the mass, and these all appear to\nbe free without any fixation. A ventral nerve root also appears deformed by\nthe mass and may show some adherence or involvement by the mass, but this is\nuncertain.", + "output": "Solid intradural a lumbar spinal canal mass, corresponding to the lesion seen\non recent MRI." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n148/44 cm/sec in its proximal portion, 86/22 cm/sec in its mid portion, and\n97/20 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n104/23 cm/sec.\nThe external carotid artery has peak systolic velocity of 120 cm/sec.\nThe vertebral artery has peak systolic velocity of 95 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.4.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n70/20 cm/sec in its proximal portion, 145/37 cm/sec in its mid portion, and\n87/22 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 73/28\ncm/sec.\nThe external carotid artery has peak systolic velocity of 159 cm/sec.\nThe vertebral artery has peak systolic velocity of 44 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.9.", + "output": "40-59% internal carotid arterial stenoses bilaterally." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with scattered\nfibroglandular tissue There is a dilated duct in the outer right breast. The\nfocal asymmetry is somewhat changeable and compressible with differences in\npositioning favoring a benign process. However, as it does persist, this was\nfurther evaluated with ultrasound. There are no associated\nmicrocalcifications.\n\nUltrasound of the right breast from ___ o'clock 0-10 cm from the nipple in\nthe area of concern on mammography was performed. This identified a dilated\nectatic ductal system centered at 9 o'clock. In this location at 7-8 cm from\nthe nipple there is a focal area of ectasia measuring 0.7 x 0.8 x 0.3 cm which\nis felt to most likely account for the finding on mammography. However, as\nthis is a somewhat unusual finding to have developed on mammography, six-month\nfollow-up right diagnostic mammogram would be prudent.", + "output": "Probable benign right breast asymmetry for which followup mammography in six\nmonths seems most reasonable approach at this time.\n\nRECOMMENDATION: Right diagnostic mammogram in six months.\n\nNOTIFICATION: Via an interpreter, findings discussed with the patient at the\ntime of imaging. The patient was provided with instructions to schedule the\nfollowup appointment upon leaving the department.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with scattered\nfibroglandular tissue There is a dilated duct in the outer right breast. The\nfocal asymmetry is somewhat changeable and compressible with differences in\npositioning favoring a benign process. However, as it does persist, this was\nfurther evaluated with ultrasound. There are no associated\nmicrocalcifications.\n\nUltrasound of the right breast from ___ o'clock 0-10 cm from the nipple in\nthe area of concern on mammography was performed. This identified a dilated\nectatic ductal system centered at 9 o'clock. In this location at 7-8 cm from\nthe nipple there is a focal area of ectasia measuring 0.7 x 0.8 x 0.3 cm which\nis felt to most likely account for the finding on mammography. However, as\nthis is a somewhat unusual finding to have developed on mammography, six-month\nfollow-up right diagnostic mammogram would be prudent.", + "output": "Probable benign right breast asymmetry for which followup mammography in six\nmonths seems most reasonable approach at this time.\n\nRECOMMENDATION: Right diagnostic mammogram in six months.\n\nNOTIFICATION: Via an interpreter, findings discussed with the patient at the\ntime of imaging. The patient was provided with instructions to schedule the\nfollowup appointment upon leaving the department.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the left breast at 5 o'clock 12-13 cm from the nipple there is an oval\ncircumscribed hypoechoic collection measuring 2.3 x 3.6 x 0.6 cm that is based\nin the dermis. An additional oval circumscribed hypoechoic collection\ncontaining echogenic debris is located at 7 o'clock 12-13 cm from the nipple\nmeasuring 5.8 x 3.3 x 1.1 cm. The second collection has a tract to the skin. \nUnder visual inspection the collection was draining.", + "output": "Two left breast abscesses in the lower inner left breast, at least 1 of which\nis draining through a skin tract.\n\nRECOMMENDATION(S): Given that the collections are actively draining and the\npatient's symptoms are improving, no aspiration is recommended at this time.\nReferral to the Breast Care Center is recommended for more formal evaluation\nof the patient's left breast. Annual baseline mammogram is recommended when\nthe patient's symptoms improve.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her appointment at\nthe Breast Care Center. In addition findings were emailed to members of the\nBreast care team as well as ___ and ___ by Dr.\n___.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the left breast at the 5 o'clock position, 12-13 cm from the nipple there\nis an oval (wider than tall), circumscribed heterogeneous but predominantly\nhypoechoic region/collection measuring 3.6 x 1.2 x 4.2 cm. The collection is\nlarger in comparison to prior exam from ___ (at that time measuring 3.6\nx 0.6 x 2.3 cm). The collection now has the appearance of internal, dependent\ncomponents which display vascularity (for example see series 1, image 16).\nThere is a draining tract communicating with the skin surface (series 1, image\n15).\n\nIn the left breast at the 7 o'clock position, also 12-13 cm from the nipple,\nthe previously demonstrated collection is significantly smaller, nearly\ncompletely collapsed, no longer with any significant internal fluid volume,\ncurrently measuring 4.6 x 0.5 x 0.9 cm.", + "output": "1. Interval enlargement of a now 3.6 x 1.2 x 4.2 cm heterogeneous,\ncircumscribed oval region/collection in the left breast at the 5 o'clock\nposition, 12-13 cm from the nipple. Although previously characterized as an\nabscess, given the appearance of possible internal solid vascularized\ncomponents, this assessment is indeterminate.\n2. Interval near-resolution of the left breast 7 o'clock position abscess. No\nsignificant internal volume.\n\nRECOMMENDATION(S): Recommend very short-term follow-up with dedicated\ndiagnostic evaluation in the Breast Care Clinic.\n\nBI-RADS-0: Requires further imaging." + }, + { + "input": "In the left breast at 7 o'clock approximately 13 cm from the nipple, there is\na 2.4 x 0.8 x 3.2 cm fluid collection with internal echoes and substantial\nechogenicity of the adjacent fat concerning for an abscess. In the left\nbreast at 8 o'clock approximately 13 cm from the nipple, there is a 0.9 x 0.5\nx 2.1 cm fluid collection with internal echoes and substantial echogenicity of\nthe adjacent fat concerning for another small abscess. This smaller abscess\nappears to have a tract draining to the epidermal surface.", + "output": "Two left breast abscesses. The first measuring up to 3.2 cm at 7 o'clock\napproximately 13 cm from the nipple and the second measuring up to 2.1 cm at 8\no'clock approximately 13 cm from the nipple. Ultrasound-guided abscess\ndrainage should be considered for the larger abscess. The smaller abscess is\nalready appears to drain to the skin surface." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nBoth breasts are without suspicious dominant mass, architectural distortion or\nsuspicious grouped calcifications. There is no discrete mass seen at the\npatient's clinical area of concern along the medial inferior breast, where\nonly fatty tissue is seen. A few skin calcifications are noted adjacent to\nthis location.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at ___ o'clock 13\ncm from the nipple at the patient's area of palpable concern demonstrates a\n2.6 x 1.2 x 2.1 cm circumscribed hyperechoic mass without dominant vascularity\nor significant posterior features. This has the appearance of a lipoma.\nIn addition, scanning at ___ o'clock 10 cm from the nipple at the patient's\nsecond area of palpable concern demonstrates a subtle 1.3 x 0.7 x 1.2 cm area\nof slightly hyperechoic tissue, without dominant vascularity or posterior\nshadowing, which may represent a fatty lobule or a second lipoma.\n\nNo suspicious dominant mass is seen at these locations.", + "output": "Left breast 2.6 cm hyperechoic mass seen best on ultrasound at ___ o'clock 13\ncm from the nipple consistent with a lipoma. Probable second lipoma versus\nfatty lobule in the adjacent tissue measuring 1.3 cm.\n\nRECOMMENDATION(S): Annual screening mammography.\nClinical followup of the palpable masses.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient\nthrough the interpreter, who agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nOn the right, there is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications.\nFocal asymmetry with spiculated margins and internal calcifications spanning\n13 mm is identified deep to the BB marker in the area of palpable concern,\nwithin the upper outer left breast.\n\nBREAST ULTRASOUND: Evaluation of the left breast palpable finding was\nperformed.\nAt 2 o'clock, 7 cm from the nipple, there is a 18 mm x 17 mm x 18 mm irregular\nhypoechoic nodule with ill-defined margins and internal vascular flow. \nMinimal posterior shadowing is noted.", + "output": "Suspicious left breast nodule accounting for the palpable finding.\n\nRECOMMENDATION(S): Same day ultrasound core biopsy will be performed.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nOn the right, there is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications.\nFocal asymmetry with spiculated margins and internal calcifications spanning\n13 mm is identified deep to the BB marker in the area of palpable concern,\nwithin the upper outer left breast.\n\nBREAST ULTRASOUND: Evaluation of the left breast palpable finding was\nperformed.\nAt 2 o'clock, 7 cm from the nipple, there is a 18 mm x 17 mm x 18 mm irregular\nhypoechoic nodule with ill-defined margins and internal vascular flow. \nMinimal posterior shadowing is noted.", + "output": "Suspicious left breast nodule accounting for the palpable finding.\n\nRECOMMENDATION(S): Same day ultrasound core biopsy will be performed.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "The left breast nodule at 2 o'clock was identified.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using two patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___.\n\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nDr. ___ was called with the results of the imaging findings on ___ at\n2:40PM. She is aware that same day biopsy was performed and will await the\npathology results." + }, + { + "input": "The left breast nodule at 2 o'clock was identified.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using two patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___.\n\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nDr. ___ was called with the results of the imaging findings on ___ at\n2:40PM. She is aware that same day biopsy was performed and will await the\npathology results." + }, + { + "input": "The previously biopsied irregular mass at 2:00 7 cm from the nipple was not\nre-imaged but was visualized with internal clip, consistent with biopsy proven\ncancer. Attention was directed to the area anterior and slightly inferior to\nthis mass, where a suspected satellite lesion was seen on recent MRI. \nAlthough a few vague hypoechoic areas were questioned, the satellite lesion\nseen on recent MRI could not be identified with certainty by ultrasound.\n\nUltrasound of the left axilla revealed sonographically normal lymph nodes. \nThe area of questioned adenopathy on MRI did not appear abnormal on today's\nultrasound.", + "output": "1. Small presumed satellite lesion seen on recent MRI is not well seen with\nultrasound, and thus could not be sampled with ultrasound guidance.\n2. Sonographically normal left axillary lymph nodes.\n\nRECOMMENDATION(S): Depending on clinical treatment plan, the presumed\nsatellite lesion anterior and slightly inferior to the biopsied mass/cancer\ncan be biopsied under MR guidance for tissue diagnosis, or wire localized with\nMR guidance on the day of surgery (with clip placed at that time).\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She states she has other imaging tests scheduled and will be following\nup with Dr. ___.\nThe findings were also discussed with Dr. ___ by Dr. ___ at 4:40 pm on ___.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque in\nthe internal carotid artery.\nThe right common carotid artery had peak systolic/diastolic velocities of\n58/10 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n76/15 cm/sec in its proximal portion, 83/20 cm/sec in its mid portion and\n72/15 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 64cm/sec.\nThe vertebral artery has peak systolic velocity of 53 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.4.\n\nLEFT:\nThe left carotid vasculature has significant heterogeneous atherosclerotic\nplaque in the internal carotid artery.\nThe left common carotid artery had peak systolic/diastolic velocities of 84/19\ncm/sec.\nThe left internal carotid artery had peak systolic/diastolic velocities of\n217/56 cm/sec in its proximal portion, 243/52 cm/sec in its mid portion and\n126/26 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 104cm/sec.\nThe vertebral artery has peak systolic velocity of 42 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 2.8.", + "output": "1. Significant heterogeneous plaque in the left internal carotid artery. 70-\n79% stenosis of the left internal carotid artery.\n2. Mild heterogeneous plaque in the right internal carotid artery. Less than\n40% stenosis of the right internal carotid artery." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n78/29 cm/sec in its proximal portion, 79/32 cm/sec in its mid portion, and\n78/29 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n87/22 cm/sec.\nThe external carotid artery has peak systolic velocity of 103 cm/sec.\nThe vertebral artery has peak systolic velocity of 45 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 0.9.\n\nLEFT:\nThe left carotid vasculature has minimal heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n68/18 cm/sec in its proximal portion, 95/25 cm/sec in its mid portion, and\n87/35 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of\n105/35 cm/sec.\nThe external carotid artery has peak systolic velocity of 164 cm/sec.\nThe vertebral artery has peak systolic velocity of 55 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.9.", + "output": "1. Minimal heterogeneous plaque in the bilateral right and left internal\ncarotid arteries. Less than 40% stenosis bilaterally." + }, + { + "input": "The patient is status post left femoral to popliteal bypass graft and left\nBKA. The left femoral to popliteal bypass graft is patent with velocities\nranging from 47 to 96 cm/sec. The native vessel proximal to the graft has\npeak systolic velocity of 100 cm/sec. The proximal anastomosis has peak\nsystolic velocity 88 cm/sec. The distal anastomosis has a peak systolic\nvelocity of 86 cm/sec. The native distal vessel has a peak systolic velocity\nof 58 cm/sec.\n\nSuperior to the common femoral vein is a hypoechoic ovoid structure measuring\n1.8 x 0.9 x 0.9 cm without signs of interior flow on color Doppler ultrasound.\n\nThere is an enlarged left inguinal lymph node measuring 1.8 x 1.0 cm.", + "output": "Patent left femoral to popiteal bypass graft.\n\nPossible small area of phlegmonous change or fluid collection adjacent to left\nCFV.\n\nEnlarged left inguinal lymph node, if there is adjacent infection, this may be\nreactive, recommend clinical correlation.\n\nNOTIFICATION: These findings were discussed over the phone with Dr. ___ by\nDr. ___ at 3:16 pm on ___ by telephone at time of discovery." + }, + { + "input": "Survey view of the transplanted kidney shows no hydronephrosis or perinephric\ncollection.", + "output": "Sonographic guidance for biopsy of the rightlower quadrant transplant kidney\nby nephrologist." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nBBs marked the areas of clinical concern as denoted by the patient. No\nunderlying mammographic abnormality is seen. There are bilateral nodular and\nfocal asymmetries, similar in appearance to the prior studies, suggesting\nbenign findings. There is no new or suspicious dominant mass, unexplained\narchitectural distortion, or suspicious grouped microcalcifications seen in\neither breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the bilateral\nbreasts, with attention to the areas of clinical concern. No discrete cystic\nor solid mass is seen bilaterally.", + "output": "No specific mammographic evidence for malignancy.\n\nRECOMMENDATION(S): Annual screening mammography. Final disposition of any\nclinical findings should be based on clinical grounds.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "An initial limited ultrasound in the region of the scar did not demonstrate a\nsubcutaneous fluid collection. Further evaluation of the proximal right thigh\nshowed some heterogenous fluid adjacent to the proximal end of the femur. \nThis is very similar in appearance when compared to the prior MRI from ___ year\nago. Following discussion with Dr. ___ was decided to proceed with\naspiration as described above.", + "output": "Successful ultrasound-guided aspiration of a heterogenous fluid collection in\nthe proximal right thigh and sent for lab analysis.-" + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAdditional views confirm a 0.4 cm circumscribed equal density mass within the\ncentral inner left breast anterior depth as well as a similar appearing 0.4 cm\nmass located slightly more superiorly mid depth. Ultrasound performed for\nfurther characterization.\n\nBREAST ULTRASOUND: At 9 o'clock left breast 4 cm from the nipple there is a\nprobably benign cluster of microcysts measuring 0.3 x 0.2 x 0.3 cm\ncorresponding to anterior mass on mammogram. At 10 o'clock left breast 6 cm\nfrom the nipple there is a 0.4 x 0.3 x 0.2 cm simple cyst corresponding to the\nmore posterior mass.", + "output": "Probably benign 0.3 cm cluster of microcysts 9 o'clock left breast 4 cm from\nthe nipple corresponding to mass seen on mammogram. Six-month follow-up\nultrasounds is recommended to ensure stability.\n\nAdditional 0.4 cm simple cyst 10 o'clock left breast corresponding to a second\ncircumscribed mass on diagnostic mammogram. No further follow-up is\nindicated.\n\nRECOMMENDATION(S): Six-month follow-up diagnostic left breast ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAdditional views confirm a 0.4 cm circumscribed equal density mass within the\ncentral inner left breast anterior depth as well as a similar appearing 0.4 cm\nmass located slightly more superiorly mid depth. Ultrasound performed for\nfurther characterization.\n\nBREAST ULTRASOUND: At 9 o'clock left breast 4 cm from the nipple there is a\nprobably benign cluster of microcysts measuring 0.3 x 0.2 x 0.3 cm\ncorresponding to anterior mass on mammogram. At 10 o'clock left breast 6 cm\nfrom the nipple there is a 0.4 x 0.3 x 0.2 cm simple cyst corresponding to the\nmore posterior mass.", + "output": "Probably benign 0.3 cm cluster of microcysts 9 o'clock left breast 4 cm from\nthe nipple corresponding to mass seen on mammogram. Six-month follow-up\nultrasounds is recommended to ensure stability.\n\nAdditional 0.4 cm simple cyst 10 o'clock left breast corresponding to a second\ncircumscribed mass on diagnostic mammogram. No further follow-up is\nindicated.\n\nRECOMMENDATION(S): Six-month follow-up diagnostic left breast ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Distended gallbladder with thickened walls consistent with acute\ncholecystitis. Focal wall defect consistent with focal perforation. Please\nrefer to the same day CT abdomen/pelvis and ultrasound for detailed evaluation\nof the gallbladder.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 5\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nA triangular marker is identified at the site of pain at the lower, slightly\ninner right breast. A BB marker is also placed at a site of a palpable lump\nin the upper outer right breast. There is no dominant mass, suspicious grouped\nmicrocalcifications, or unexplained architectural distortion in the right\nbreast. Underlying the BB marker, there is a small morphologically\nnormal-appearing lymph node.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast in the area of\npalpable abnormality and pain was performed. At the site of the palpable\nregion at 10 o'clock, 11 cm from the nipple, normal breast tissue is present\nwith an incidentally noted morphologically normal, reniform shaped lymph node.\nAt the site of pain at ___ o'clock, 1 - 5 cm from the nipple, there is normal\nbreast tissue without a suspicious solid or cystic mass.", + "output": "No specific mammographic or sonographic evidence of malignancy at the sites of\npalpable abnormality and pain in the right breast.\n\nRECOMMENDATION(S): Return to annual surveillance mammogram, due in ___, according to the patient.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nA triangular marker is identified at the site of pain at the lower, slightly\ninner right breast. A BB marker is also placed at a site of a palpable lump\nin the upper outer right breast. There is no dominant mass, suspicious grouped\nmicrocalcifications, or unexplained architectural distortion in the right\nbreast. Underlying the BB marker, there is a small morphologically\nnormal-appearing lymph node.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast in the area of\npalpable abnormality and pain was performed. At the site of the palpable\nregion at 10 o'clock, 11 cm from the nipple, normal breast tissue is present\nwith an incidentally noted morphologically normal, reniform shaped lymph node.\nAt the site of pain at ___ o'clock, 1 - 5 cm from the nipple, there is normal\nbreast tissue without a suspicious solid or cystic mass.", + "output": "No specific mammographic or sonographic evidence of malignancy at the sites of\npalpable abnormality and pain in the right breast.\n\nRECOMMENDATION(S): Return to annual surveillance mammogram, due in ___, according to the patient.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nLEFT BREAST: Posttreatment changes are seen in the upper, outer left breast. \nA new 0.4 cm circumscribed mass is seen in the upper, slightly outer left\nbreast at posterior depth. This was further evaluated with targeted\nultrasound.\n\nRIGHT BREAST: A circumscribed mass in the central right breast at posterior\ndepth is stable dating to ___, consistent with a benign process, such as an\nintramammary lymph node. No suspicious mass, unexplained architectural\ndistortion, or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound is performed in the area of\nmammographic mass.\n\nAt 1 o'clock, 7 cm from nipple there is a 0.4 x 0.3 x 0.4 cm oval hypoechoic\ncircumscribed mass with no internal vascularity or significant posterior\nfeatures.", + "output": "1. Indeterminate mass in the left breast at 1 o'clock, 7 cm from the nipple is\nnew, and ultrasound-guided core biopsy is recommended for further evaluation.\n2. No specific evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided left breast biopsy.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\nAdditionally, the findings and recommendations were communicated via email to\nDr. ___ at 12:02 on ___ by ___, M.D..\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nLEFT BREAST: Posttreatment changes are seen in the upper, outer left breast. \nA new 0.4 cm circumscribed mass is seen in the upper, slightly outer left\nbreast at posterior depth. This was further evaluated with targeted\nultrasound.\n\nRIGHT BREAST: A circumscribed mass in the central right breast at posterior\ndepth is stable dating to ___, consistent with a benign process, such as an\nintramammary lymph node. No suspicious mass, unexplained architectural\ndistortion, or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound is performed in the area of\nmammographic mass.\n\nAt 1 o'clock, 7 cm from nipple there is a 0.4 x 0.3 x 0.4 cm oval hypoechoic\ncircumscribed mass with no internal vascularity or significant posterior\nfeatures.", + "output": "1. Indeterminate mass in the left breast at 1 o'clock, 7 cm from the nipple is\nnew, and ultrasound-guided core biopsy is recommended for further evaluation.\n2. No specific evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided left breast biopsy.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\nAdditionally, the findings and recommendations were communicated via email to\nDr. ___ at 12:02 on ___ by ___, M.D..\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "At 1 o'clock, 7 cm from the nipple there is a 0.4 x 0.3 x 0.4 cm hypoechoic\nmass. This was targeted for ultrasound-guided core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Sertera spring-loaded biopsy device. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views demonstrate the ribbon clip\nimmediately adjacent to the mass. There is no significant hematoma.", + "output": "Technically successful US-guided core biopsy of the left breast mass at 1\no'clock. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "At 1 o'clock, 7 cm from the nipple there is a 0.4 x 0.3 x 0.4 cm hypoechoic\nmass. This was targeted for ultrasound-guided core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Sertera spring-loaded biopsy device. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views demonstrate the ribbon clip\nimmediately adjacent to the mass. There is no significant hematoma.", + "output": "Technically successful US-guided core biopsy of the left breast mass at 1\no'clock. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\n\nPost surgical changes are present in the left breast. There is a 2 mm mass in\nthe upper outer left breast that appear circumscribed. Additional imaging\nwith ultrasound will be performed. Mass in the central right breast is stable\nover multiple exams and is benign. No additional abnormalities are seen in\neither breast.\n\nLEFT BREAST ULTRASOUND: Targeted left breast ultrasound was performed. At 1\no'clock 5 cm from the nipple there is a 0.3 x 0.2 x 0.3 cm circumscribed\nisoechoic mass with surrounding echogenicity. There is minimal increased\nblood flow. This corresponds well to the mammographic finding. Given the\nsmall size, it is not clear whether this represents a small area of developing\nfat necrosis or a lymph node. Six-month follow-up left breast ultrasound is\nrecommended.", + "output": "New 3 mm left breast mass seen on mammography and ultrasound. It is not clear\nwhether this represents a small lymph node or developing area of fat necrosis.\nSix-month follow-up left breast ultrasound is recommended.\n\nRECOMMENDATION(S): Six-month follow-up left breast ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "There are scattered areas of fibroglandular density. In the upper outer right\nbreast there is a 7.1 x 5.6 x 8.2 mm oval, circumscribed mass with coarse,\npopcorn-like calcifications.There is no architectural distortion or suspicious\ngrouped microcalcifications.\n\nUltrasound of the right breast at 11 o'clock, 4 cm from the nipple, in the\narea of concern on mammography, demonstrates a 0.6 x 0.6 x 0.5 cm oval mass\nwith heterogeneous internal echotexture and posterior shadowing but without\ndominant vascularity, most likely representing an involuted fibroadenoma. \nHowever, given the patient's age and increased size of the mass compared to\nprior mamomgraphic exams, ultrasound-guided core biopsy would be a prudent\napproach at this time.", + "output": "Enlarging right breast mass at 11 o'clock, for which ultrasound-guided core\nbiopsy would be prudent.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy upon leaving the department. Findings were also emailed by ___\nMD to ___ on ___ who confirmed receipt.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "There are scattered areas of fibroglandular density. In the upper outer right\nbreast there is a 7.1 x 5.6 x 8.2 mm oval, circumscribed mass with coarse,\npopcorn-like calcifications.There is no architectural distortion or suspicious\ngrouped microcalcifications.\n\nUltrasound of the right breast at 11 o'clock, 4 cm from the nipple, in the\narea of concern on mammography, demonstrates a 0.6 x 0.6 x 0.5 cm oval mass\nwith heterogeneous internal echotexture and posterior shadowing but without\ndominant vascularity, most likely representing an involuted fibroadenoma. \nHowever, given the patient's age and increased size of the mass compared to\nprior mamomgraphic exams, ultrasound-guided core biopsy would be a prudent\napproach at this time.", + "output": "Enlarging right breast mass at 11 o'clock, for which ultrasound-guided core\nbiopsy would be prudent.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy upon leaving the department. Findings were also emailed by ___\nMD to ___ on ___ who confirmed receipt.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Right breast mass at 11 o'clock position 5 cm from the nipple., anterior\nthird.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D.\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 12-gauge Celero vacuum assisted device, 5 cores were obtained. \nNext, a percutaneous dumbbell shaped clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from Dr. ___ In\n___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Right breast mass at 11 o'clock position 5 cm from the nipple., anterior\nthird.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D.\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 12-gauge Celero vacuum assisted device, 5 cores were obtained. \nNext, a percutaneous dumbbell shaped clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from Dr. ___ In\n___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Limited grayscale ultrasound imaging of the right cervical neck demonstrated\nseveral lymph nodes including a round level III/IV lymph node measuring up to\n8 mm, which was targeted for fine needle aspiration.\n\nPROCEDURE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained from the patient. A pre-procedure timeout using three\npatient identifiers was performed as per ___ protocol.\n\nThe patient was placed in a supine position on the US scan table. Limited\npre-procedure ultrasound of the right neck was performed. Based on the\nultrasound findings an appropriate position for the fine needle aspiration was\nchosen. The site was marked.\n\nThe site was prepped in the usual aseptic fashion. 2 cc of 1% lidocaine were\nadministered to the subcutaneous and deep tissues for local anesthetic effect.\nUnder continuous ultrasound guidance, a 25 gauge needle was used for fine\nneedle aspiration x 2 passes. The specimen was evaluated by an onsite\ncytologist and deemed adequate.\n\nThe procedure was well tolerated and there were no immediate post-procedural\ncomplications.\n\nDr. ___, the attending radiologist, was present throughout the\nentire procedure.", + "output": "Technically successful fine needle aspiration of right level III/IV cervical\nlymph node. No immediate post-procedural complications. Pathology is pending." + }, + { + "input": "The patient initially had ultrasound evaluation of the left breast, targeted\nto the reported mammographic abnormality. The entire left retroareolar,\ninferior, on lateral breast were scanned. Several retroareolar ducts were\nseen but no discrete cystic or solid mass or intraductal abnormality could be\nidentified on ultrasound. Given the appearance on mammography, and in\ncomplete evaluation on ___, additional imaging with tomosynthesis\nwas obtained.\n\nTissue density: B - There are scattered areas of fibroglandular density.\nThere is a persistent vague isodense focal asymmetry in the left central the\nslightly lower, slightly outer, mid to posterior depth breast. On\ntomosynthesis views there is a suggestion of associated architectural\ndistortion. There is no suspicious grouped microcalcifications.", + "output": "Subtle persistent focal asymmetry with possible associated distortion on\nmammography, without sonographic correlate.\n\nRECOMMENDATION(S): Stereotactic core biopsy is recommended for tissue\ndiagnosis. The possibility of non visualization on the 2D stereotactic prone\ntable was also discussed, with options of imaging followup, MRI, and wire\nlocalization.\n\nNOTIFICATION: Findings and recommendations were discussed at length with the\npatient with an interpreter. Due to other commitments, the patient has\nelected to schedule stereotactic core biopsy on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "The patient initially had ultrasound evaluation of the left breast, targeted\nto the reported mammographic abnormality. The entire left retroareolar,\ninferior, on lateral breast were scanned. Several retroareolar ducts were\nseen but no discrete cystic or solid mass or intraductal abnormality could be\nidentified on ultrasound. Given the appearance on mammography, and in\ncomplete evaluation on ___, additional imaging with tomosynthesis\nwas obtained.\n\nTissue density: B - There are scattered areas of fibroglandular density.\nThere is a persistent vague isodense focal asymmetry in the left central the\nslightly lower, slightly outer, mid to posterior depth breast. On\ntomosynthesis views there is a suggestion of associated architectural\ndistortion. There is no suspicious grouped microcalcifications.", + "output": "Subtle persistent focal asymmetry with possible associated distortion on\nmammography, without sonographic correlate.\n\nRECOMMENDATION(S): Stereotactic core biopsy is recommended for tissue\ndiagnosis. The possibility of non visualization on the 2D stereotactic prone\ntable was also discussed, with options of imaging followup, MRI, and wire\nlocalization.\n\nNOTIFICATION: Findings and recommendations were discussed at length with the\npatient with an interpreter. Due to other commitments, the patient has\nelected to schedule stereotactic core biopsy on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. A small mass in the upper outer right breast is stable\nconsistent with an intramammary lymph node. No suspicious mass, area of\narchitectural distortion or cluster of suspicious microcalcification is\nappreciated in either breast.\n\nUltrasound of the right breast from ___ o'clock 1-12 cm from the nipple and\nthe left breast from ___ o'clock 1-12 cm from the nipple was performed\ncorresponding to the areas of tenderness as indicated by the patient. No\nsolid suspicious mass or cystic lesion is seen. Further management of the\npatient's symptoms at this time should be based on the clinical assessment.", + "output": "No focal mammographic or sonographic abnormalities identified in either breast\nin the areas of tenderness as indicated by the patient. Further management of\npatient's symptoms at this time should be based on the clinical assessment.\n\nRECOMMENDATION: Annual screening mammography. Clinical followup.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere was an initially noted asymmetry measuring approximately 5 cm in the\ninner right breast on the CC view at posterior depth. This asymmetry does not\nefface completely on tomosynthesis compression views but is less prominent\nwithout associated architectural distortion, calcification, or spiculation. \nThis asymmetry is not clearly identified on orthogonal views. Of note, the\nasymmetry may not have been imaged, due to its posterior position, on prior\nmammogram dated ___. A well-circumscribed round dense mass measuring\napproximately 6 mm in maximal diameter in the upper outer right breast at mid\ndepth is unchanged dating back to mammogram ___.\n\nRight breast ultrasound:\nUltrasound of the entire inner right breast shows no focal mass or cyst\ncorrespond.", + "output": "Probably benign asymmetry in the right breast, only seen on CC views,\nmeasuring approximately 5 cm without sonographic correlate. Of note, is\nasymmetry may not have been imaged on mammogram ___ due to its\nposterior position.\n\nRECOMMENDATION(S): Diagnostic right mammogram in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Limited preprocedure ultrasound demonstrates an approximately 5.2 x 4.4 cm\nheterogeneous fluid collection with internal echoes involving the left kidney,\nextending to the left perinephric space between the spleen and colon. This\nwas targeted for drainage.", + "output": "US-guided placement of ___ pigtail catheter into the left perinephric\ncollection yielding dark sanguinous material. Samples were sent for\nmicrobiology and cytology evaluation. An underlying mass with chronic hematoma\ncannot be excluded.\n\nRECOMMENDATION(S): If the microbiology evaluation is negative, we recommend\nremoving the catheter to avoid seeding the hematoma.\n\nNOTIFICATION: The findings and recommendations were discussed by Dr. ___\n___ with Dr. ___ on the telephone on ___ at 4:31PM, upon\nprocedure completion." + }, + { + "input": "Intra procedural ultrasound demonstrates appropriate positioning of the biopsy\nneedle within the hypoechoic right paraspinal lesion.", + "output": "Technically successful ultrasound-guided biopsy of a right paraspinal lesion." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.5 L of clear, straw-colored ascitic fluid were removed.\nFluid samples were submitted to the laboratory for cell count, differential,\nand culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, yielding 3.5 L of clear, straw-colored ascitic fluid. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.5 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.5 L of fluid were removed." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 70, 82, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 149 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque. \nModerate intimal thickening is noted involving the left CCA.\nThe peak systolic velocity in the left common carotid artery is 130 set\ncm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 71, 92, and 110 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 38 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 237 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right: Mild heterogeneous atherosclerotic plaque (less than 40% stenosis)\nLeft: Mild heterogeneous intimal thickening in the common carotid artery (less\nthan 40% stenosis)" + }, + { + "input": "The liver is diffusely echogenic with a smooth contour, and no focal lesions\nor intrahepatic biliary duct dilatation. Multiple highly echogenic punctate\nand linear foci within the liver are compatible with pneumobilia. There is no\nintrahepatic biliary duct dilatation. Numerous large stones are\nredemonstrated in the gallbladder, with the largest measuring all 2 cm of\ndiameter. There is no gallbladder wall thickening or pericholecystic fluid. \nThe common bile duct is dilated, measuring 10 mm of caliber, slightly\nincreased from prior exam when it measured 7 mm. There is no evidence of\ncholedocholithiasis. There is no perihepatic fluid. Limited views of the\nright kidney are grossly unremarkable.\n\nSPECTRAL DOPPLER ANALYSIS OF THE LIVER VASCULATURE. The main portal vein is\npatent with hepatopetal flow. The main, right, and left hepatic arteries are\nalso patent, with appropriate waveforms and directionality of flow. The left,\nmiddle, right hepatic veins are patent with appropriate directionality of\nflow.", + "output": "1. New minimal pneumobilia with slight increase in caliber of the common bile\nduct may be secondary to recent passage of a gallstone. No gallstone seen\nwithin the common bile duct.\n\n2. Cholelithiasis without evidence of cholecystitis.\n\n3. No evidence of portal vein thrombosis.\n\n4. Diffusely echogenic liver is compatible with hepatic steatosis. However\nchronic liver disease such as cirrhosis/fibrosis cannot be excluded on the\nbasis of this exam." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a partially obscured 0.6 cm oval mass within the upper slightly outer\nright breast mid to anterior depth corresponding to palpable abnormality as\ndenoted by skin marker. There are expected postsurgical changes within the\nleft breast. There is no additional dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: At 1 o'clock right breast 5 cm from the nipple\ncorresponding to palpable abnormality as indicated by the patient there is a\n0.5 x 0.2 x 0.5 cm oval circumscribed mass with parallel orientation and no\nsignificant internal color flow. Imaging characteristics favor a benign\nfibroadenoma.", + "output": "0.5 cm probably benign mass 1 o'clock right breast corresponding to palpable\nabnormality. Six-month follow-up ultrasound recommended to document\nstability.\n\nRECOMMENDATION(S): Six-month follow-up diagnostic right breast ultrasounds\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up. \nThe patient was also given contact information for breast Care Center in the\nevent that she would like to have the mass excised.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a partially obscured 0.6 cm oval mass within the upper slightly outer\nright breast mid to anterior depth corresponding to palpable abnormality as\ndenoted by skin marker. There are expected postsurgical changes within the\nleft breast. There is no additional dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: At 1 o'clock right breast 5 cm from the nipple\ncorresponding to palpable abnormality as indicated by the patient there is a\n0.5 x 0.2 x 0.5 cm oval circumscribed mass with parallel orientation and no\nsignificant internal color flow. Imaging characteristics favor a benign\nfibroadenoma.", + "output": "0.5 cm probably benign mass 1 o'clock right breast corresponding to palpable\nabnormality. Six-month follow-up ultrasound recommended to document\nstability.\n\nRECOMMENDATION(S): Six-month follow-up diagnostic right breast ultrasounds\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up. \nThe patient was also given contact information for breast Care Center in the\nevent that she would like to have the mass excised.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound 1 o'clock right breast 5 cm from the nipple again\ndemonstrates an oval circumscribed hypoechoic mass. On today's examination\nthis measures 0.6 x 0.6 x 0.4 cm which is minimally larger compared to the\nprior study where it measured 0.5 x 0.5 x 0.2 cm.", + "output": "Minimal interval enlargement right breast mass currently measuring 0.6 cm. \nAlthough the difference in size may be technical, the patient feels that the\nmass is larger than when she first initially detected it and is requesting\nultrasound-guided biopsy this time which is reasonable.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy right breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan. She was given information to schedule her\nbiopsy. The findings were communicated to ___, M.D. by ___\n___, M.D. by email on ___ at 8:29 am.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Again seen in the right breast at 1 o'clock 5 cm from the nipple is a\nsuperficial hypoechoic oval-shaped mass which was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by ___,\nM.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 15 gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 16 gauge ___ biopsy device. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The ribbon\nclip is on the medial aspect of the lesion. The needle was removed and\nhemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement, on the medial side lesion.", + "output": "Technically successful US-guided core biopsy of the right breast mass.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Again seen in the right breast at 1 o'clock 5 cm from the nipple is a\nsuperficial hypoechoic oval-shaped mass which was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by ___,\nM.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 15 gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 16 gauge ___ biopsy device. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The ribbon\nclip is on the medial aspect of the lesion. The needle was removed and\nhemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement, on the medial side lesion.", + "output": "Technically successful US-guided core biopsy of the right breast mass.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in left lobe of the liver in\nsegment 3. There were no other concerning incidental findings.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\nUnder real-time ultrasound guidance, one 18-gauge core biopsy samples obtained\nof the segment 3 lesion. The sample was placed in formalin and sent for\npathology.", + "output": "Successful biopsy of left lateral segment liver lesion" + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Accessory breast tissue corresponds to the areas of\npalpable concern in both axillary regions marked by a radiopaque marker.\n\nBREAST ULTRASOUND: Targeted ultrasound of both axillary regions in the areas\nof palpable lumps was performed. There is mostly fatty tissue with small\namount of breast parenchyma corresponding to palpable lumps in both axillary\nregions. No suspicious cystic or solid masses. Normal axillary lymph nodes\nare seen.", + "output": "Palpable lumps in both axillary regions correspond to axillary accessory\nbreast tissue.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Accessory breast tissue corresponds to the areas of\npalpable concern in both axillary regions marked by a radiopaque marker.\n\nBREAST ULTRASOUND: Targeted ultrasound of both axillary regions in the areas\nof palpable lumps was performed. There is mostly fatty tissue with small\namount of breast parenchyma corresponding to palpable lumps in both axillary\nregions. No suspicious cystic or solid masses. Normal axillary lymph nodes\nare seen.", + "output": "Palpable lumps in both axillary regions correspond to axillary accessory\nbreast tissue.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the region of the palpable abnormality as indicated by the patient, no\nunderlying mass is identified. The visualized distal quadriceps is\nunremarkable without evidence of tear. No increased vascularity. The\nunderlying subcutaneous tissues are normal in appearance.", + "output": "No sonographic evidence of a mass in the region of the palpable abnormality as\nindicated by the patient. An un encapsulated lipoma or areas of fat necrosis\nmay not be visible on ultrasound imaging may be better evaluated with an MRI\nwith without contrast." + }, + { + "input": "No soft tissue mass identified in the first or second web space to suggest a\n___ neuroma. The overlying tendons are normal in appearance. There is a\npunctate hyperechoic focus adjacent the second metatarsal head with posterior\nshadowing likely representing calcification, likely a small osteophyte or the\nsequela of prior injury. No abnormal increased vascularity. Dedicated images\nof the first and second plantar plate do not demonstrate any abnormality.", + "output": "No cause for the patient's symptoms identified on the current study." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThe breast tissue is heterogeneously dense which may obscure the detection for\nsmall masses. There is no suspicious dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications. He left intramammary\nlymph node is noted.\n\nBILATERAL BREAST ULTRASOUND:\n\nBoth retroareolar regions were scanned and no abnormality is identified.", + "output": "No imaging correlate for the area of clinical concern in the retroareolar\nregions of both breasts. Further management should be based on the clinical\nassessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "A targeted right breast ultrasound at the 2 o'clock position 3 cm from the\nnipple in the palpable area of concern demonstrates a 1.1 x 0.8 x 0.6 cm\nhypoechoic mass that is wider than tall without and no internal vascularity. \nThere is suggestion of increased posterior through transmission.", + "output": "Palpable abnormality corresponds to a probably benign 1.1 x 0.8 x 0.6 cm\nhypoechoic mass at the 2 o'clock position 3 cm from the nipple in the right\nbreast, possibly representing a fibroadenoma or cluster of cysts. The need\nfor complete evaluation with the diagnostic mammography was addressed in\ndetail with the patient.\n\nRECOMMENDATION: A diagnostic mammogram is recommended to complete evaluation.\nAssuming no other findings identified on the mammogram, patient should return\nin 6 months for a right breast ultrasound to assess interval stability." + }, + { + "input": "Mammogram:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a radiopaque marker placed in the inner right breast at anterior\ndepth in the area of palpable concern. There is a subtle density, however no\ndiscrete mass in the area of palpable concern. There are no suspicious\ncalcifications or areas of architectural distortion in the right breast.\n\nPlease note that the lateral view of the right breast was initially\nincorrectly labeled as Left Breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the area of palpable concern was\nperformed. In the 2 o'clock position approximately 5 cm from the nipple there\nis an 9x 3 x 5 mm hypoechoic irregular mass with adjacent vascularity and no\ndefinitive through transmission.", + "output": "There is an approximately 9 mm indeterminate mass in the area of palpable\nconcern in the upper inner right breast. Further evaluation with\nultrasound-guided core needle biopsy is recommended for tissue diagnosis.\n\nRECOMMENDATION: Ultrasound-guided core needle biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy and reported in an email to Dr. ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Mammogram:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a radiopaque marker placed in the inner right breast at anterior\ndepth in the area of palpable concern. There is a subtle density, however no\ndiscrete mass in the area of palpable concern. There are no suspicious\ncalcifications or areas of architectural distortion in the right breast.\n\nPlease note that the lateral view of the right breast was initially\nincorrectly labeled as Left Breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the area of palpable concern was\nperformed. In the 2 o'clock position approximately 5 cm from the nipple there\nis an 9x 3 x 5 mm hypoechoic irregular mass with adjacent vascularity and no\ndefinitive through transmission.", + "output": "There is an approximately 9 mm indeterminate mass in the area of palpable\nconcern in the upper inner right breast. Further evaluation with\nultrasound-guided core needle biopsy is recommended for tissue diagnosis.\n\nRECOMMENDATION: Ultrasound-guided core needle biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy and reported in an email to Dr. ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "In the right breast at the 2 o'clock position 5 cm from the nipple is a 0.6 x\n0.3 x 0.7 cm oval, parallel, circumscribed, lesion with both anechoic and\nhypoechoic components and faint posterior acoustic enhancement, without\ninternal vascularity. On ___ this lesion measured 1.1 x 0.9 x 0.7 cm\nand on ___ it measured 0.9 x 0.5 x 0.2 cm. This is consistent with a\ncyst with internal debris and septation.\n\nScanning of the right upper outer quadrant was performed. There is a similar\nhypo/anechoic lesion in the right breast at the 11 o'clock position 2 cm from\nthe nipple measuring 0.6 x 0.3 x 0.4 cm and a 0.8 x 0.3 x 0.6 cm anechoic\nretroareolar cyst with septations at the 12 o'clock 0 cm.", + "output": "The previously described right breast 1.1 cm hypoechoic mass at the 2 o'clock\n5 cm, has decreased in size since ___ and is most compatible with a\nresolving complicated cyst. Several other complicated cysts are seen in the\nright breast.\n\nGiven interval decrease in size and presence of other similar lesions in the\nright breast, a 6 month followup ultrasound rather than aspiration was offered\nas an option to the patient. The patient preferred to not pursue\naspiration/biopsy at this time and instead wishes to proceed with 6 month\nfollow-up of all of the complicated cysts.\n\nRECOMMENDATION: 6 month ultrasound followup for several complicated cysts in\nthe right breast.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound was performed in the right breast at 2 o'clock 5 cm from\nthe nipple in location of previously identified hypoechoic mass. A 6 x 2 x 5\nmm hypoechoic, circumscribed, oval mass appears slightly decreased in size\ncompared to prior studies from ___ and ___, suggesting a\npossible resolving cyst. Given point tenderness in this region, patient\nrequests aspiration.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., N. ___, N.P., ___, M.D.. The procedure\nwas supervised by T. ___, M.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, initially an 22 gauge needle was utilized in an attempt to\naspirate the presumed complicated cyst. No fluid was obtained therefore\nanother attempt was made with an 18 gauge needle and a small amount of fluid\nwas aspirated, however the lesion did not resolve. Given persistence of the\nlesion, after discussion with the patient, a decision was made to perform\nultrasound-guided core biopsy.\n\nUnder ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and 4 cores were\nobtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous clip was deployed under ultrasound guidance. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 5 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. Due to breast tissue density, the lesion seen on ultrasound is not\nwell seen mammographically.", + "output": "Ultrasound-guided cyst aspiration of the 2 o'clock lesion 5 cm from the nipple\nwas performed. As the lesion did not completely resolve, ultrasound-guided\ncore biopsy and clip placement was also performed. Pathology is pending. \nAssuming benign results, patient will also require six-month followup\nultrasound for continued surveillance of the other presumed complicated cysts\nseen in this breast on ___.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Resident / Fellow\nduring the key components of the above procedure and I reviewed and agree with\nthe Resident's / Fellow's findings and dictation." + }, + { + "input": "Targeted ultrasound was performed in the right breast at 2 o'clock 5 cm from\nthe nipple in location of previously identified hypoechoic mass. A 6 x 2 x 5\nmm hypoechoic, circumscribed, oval mass appears slightly decreased in size\ncompared to prior studies from ___ and ___, suggesting a\npossible resolving cyst. Given point tenderness in this region, patient\nrequests aspiration.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., N. ___, N.P., ___, M.D.. The procedure\nwas supervised by T. ___, M.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, initially an 22 gauge needle was utilized in an attempt to\naspirate the presumed complicated cyst. No fluid was obtained therefore\nanother attempt was made with an 18 gauge needle and a small amount of fluid\nwas aspirated, however the lesion did not resolve. Given persistence of the\nlesion, after discussion with the patient, a decision was made to perform\nultrasound-guided core biopsy.\n\nUnder ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and 4 cores were\nobtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous clip was deployed under ultrasound guidance. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 5 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. Due to breast tissue density, the lesion seen on ultrasound is not\nwell seen mammographically.", + "output": "Ultrasound-guided cyst aspiration of the 2 o'clock lesion 5 cm from the nipple\nwas performed. As the lesion did not completely resolve, ultrasound-guided\ncore biopsy and clip placement was also performed. Pathology is pending. \nAssuming benign results, patient will also require six-month followup\nultrasound for continued surveillance of the other presumed complicated cysts\nseen in this breast on ___.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Resident / Fellow\nduring the key components of the above procedure and I reviewed and agree with\nthe Resident's / Fellow's findings and dictation." + }, + { + "input": "Targeted ultrasound the right breast is performed. In the right breast at 12\no'clock in the retroareolar region is a 1.2 x 0.2 x 0.9 cm well-circumscribed,\nhypoechoic, avascular lesion which is consistent with a cyst with debris. A\nsimilar 4 x 2 x 5 mm cyst with debris, is noted in the right breast at 11\no'clock 2 cm from the nipple.", + "output": "Cysts with debris in the right breast as described. No solid lesion of\nconcern.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography starting\nage ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is re- demonstration of a 1.3 x 0.9 x 1.2 cm mass at 1 o'clock 6-7 cm\nfrom the nipple in the left breast.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a ribbon clip was placed within the mass at 1 o'clock 6-7 cm\nfrom the nipple. Subsequently, a ___ needle and wire were advanced towards\nthe target and positioned such that the mass was centered at the wires\nstiffener. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip and\nwire placement.\n\nPrinted and annotated images were sent to the operating room with the patient.", + "output": "Technically successful US-guided wire localization of the left breast mass." + }, + { + "input": "There is re- demonstration of a 1.3 x 0.9 x 1.2 cm mass at 1 o'clock 6-7 cm\nfrom the nipple in the left breast.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a ribbon clip was placed within the mass at 1 o'clock 6-7 cm\nfrom the nipple. Subsequently, a ___ needle and wire were advanced towards\nthe target and positioned such that the mass was centered at the wires\nstiffener. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip and\nwire placement.\n\nPrinted and annotated images were sent to the operating room with the patient.", + "output": "Technically successful US-guided wire localization of the left breast mass." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 68, 53, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.89.\nThe external carotid artery has peak systolic velocity of 143 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 50, 50, and 63 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.84.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. No plaque or stenosis noted in the internal carotid. No hemodynamically\nsignificant stenosis right internal carotid (less than 40%).\n\n2. Antegrade flow noted both vertebral arteries." + }, + { + "input": "Transabdominal and endovaginal ultrasound were performed, the\nlatter to better demonstrate the endometrium and ovaries. The anteverted\nuterus measures 8 x 5.5 x 5.7 cm similar to prior. In the right lateral\nfundal area there is a fibroid measuring 5.2 x 4.4 x 5.7 cm which distorts the\nendometrium which measures to 7 mm. The left ovary appears normal and the\nright is not visualized. There is no evidence for adnexal masses, no free\nfluid. There is no hydronephrosis.", + "output": "1. Fibroid uterus with fibroid slightly smaller than on prior.\n2. Endometrial thickness essentially unchanged from prior." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with scattered\nfibroglandular and fibronodular tissue which somewhat lowers the sensitivity\nof mammography. The asymmetry in the central outer left breast does not\npersist and is felt to correspond to superimposed breast tissue. However, due\nto the density of the tissue, ultrasound of this area was undertaken.\n\nThere is a persistent mass with a few associated punctate calcifications in\nthe slightly upper inner anterior right breast which on mammography is stable\ndating back to at least ___ and therefore is consistent with a benign\nfinding. This was also further evaluated with ultrasound.\n\nUltrasound the left breast from ___ o'clock 1-10 cm from the nipple in the\narea of concern on mammography was performed. At ___ o'clock 3 cm from the\nnipple is identified a 0.8 x 0.8 x 0.4 cm solid benign appearing mass which is\nunchanged dating back to ___ and therefore is consistent with a benign\nfinding such as a fibroadenoma. No suspicious solid lesion or cystic\nabnormality is appreciated.\n\nUltrasound of the right breast at 2 o'clock 3 cm from the nipple in the area\nof concern on mammography identified a 1.0 x 0.6 x 1.0 cm macrolobulated mass\nconsistent with a fibroadenoma given stability on mammography for at least ___\nyears. No solid suspicious lesion or cystic mass is appreciated.", + "output": "Bilateral asymmetries on recent screening mammogram ___ either\ncorresponding to superimposed breast tissue or stable benign findings as\ndescribed above. The patient may resume routine mammographic screening.\n\nRECOMMENDATION: Annual mammography\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is normal respiratory variation in both common femoral veins.\nThere is normal compressibility and augmentation of the right common femoral,\nsuperficial femoral, popliteal, posterior tibial, and peroneal veins. A\n___ cyst is again seen in the right popliteal fossa, measuring 5.3 x 2.2 x\n2.2 cm.", + "output": "No evidence of deep vein thrombosis in the right lower extremity veins. Right\n___ cyst." + }, + { + "input": "There are no suspicious cystic or solid masses in the right axilla in the area\nindicated by the patient where she previously felt a lump. Normal-appearing\nlymph nodes are seen. Directed physical examination of the right axilla\nreveals no definite palpable abnormalities.", + "output": "There are no suspicious sonographic findings in the right axilla. The patient\nreports that previously felt by her palpable lump has resolved.\n\nRECOMMENDATION(S): Clinical followup for any palpable areas of concern. \nFinal patient disposition and any decision to biopsy should be based on\nclinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\n\nThe right internal carotid artery has peak systolic velocities of 82 cm/sec in\nits proximal portion, 89 cm/sec in its mid portion and 71 cm/sec in its distal\nportion.\n\nThe right common carotid artery had peak systolic velocities of 99 cm/sec.\n\nThe right external carotid artery has peak systolic velocity of 82cm/sec.\n\nFlow in the right vertebral artery is antegrade.\n\nThe right ICA/CCA ratio is 0.89 cm.\n\nLEFT:\n\nThe left internal carotid artery has peak systolic velocities of 71 cm/sec in\nits proximal portion, 110 cm/sec in its mid portion and 62 cm/sec in its\ndistal portion.\n\nThe left common carotid artery had peak systolic velocities of 103 cm/sec.\n\nThe left external carotid artery has peak systolic velocity of 60cm/sec.\n\nFlow in the left vertebral artery is antegrade.\n\nThe left ICA/CCA ratio is 1.07.", + "output": "Normal carotid ultrasound" + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained with the help of an\ninterpreter.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.5 L of serosanguinous fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 6 L of clear, straw-colored fluid were removed. Specimens\nwere sent for requested labs.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 6 L of fluid were removed." + }, + { + "input": "In the 9 o'clock, 11 cm from the nipple there is a normal-appearing\nintramammary lymph node which measures 0.5 x 0.2 x 0.3 cm and demonstrates\nnormal echogenic hilum with hilar blood flow, normal cortical contour and\ncortical thickness. This corresponds to the small enhancing mass seen on the\nrecent MRI.", + "output": "Normal-appearing intramammary lymph node in the 9 o'clock right breast\ncorresponding to the enhancing mass seen on MRI. This has benign imaging\nappearance.\n\nRECOMMENDATION(S): No specific imaging followup for this is required. Age\nand risk appropriate screening is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 72.1 cm/s / 15.8 cm/s\nCCA Distal: 74.5 cm/s / 16.4 cm/s\nICA ___: 71.4 cm/s / 15.9 cm/s\nICA Mid: 64.6 cm/s / 16.9 cm/s\nICA Distal: 50.4 cm/s / 15.8 cm/s\nECA: 151 cm/s\nVertebral: 56.3 cm/s\n\nICA/CCA Ratio: 0.96\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 102 cm/s / 23.6 cm/s\nCCA Distal: 82.5 cm/s / 19.6 cm/s\nICA ___: 48.1 cm/s / 12.3 cm/s\nICA Mid: 65.7 cm/s / 23.5 cm/s\nICA Distal: 57.5 cm/s / 18.2 cm/s\nECA: 115 cm/s\nVertebral: 29 cm/s\n\n\nICA/CCA Ratio: 0.8\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Ultrasound the right radio artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nRight radial artery: The radial artery is patent. There is retrograde filling\nof the ulnar artery. There is no evidence of thrombus or dissection.\n\nRight vertebral artery: Vessel caliber smooth and regular. There is\nopacification of the basilar artery as well as bilateral superior cerebellar\narteries and the right posterior cerebral artery. There is reflux in the\ncontralateral codominant vertebral artery. There is minimal filling of the\nleft PCA which is new from the previous angiogram. There is no residual\nfilling of the previously identified aneurysm. There is no additional\naneurysm or AVM. The venous phase is unremarkable. There is slight stenosis\nat the origin of the bilateral superior cerebellar arteries. There is no\nresidual filling of the aneurysm as confirmed on three-dimensional rotational\npictures.", + "output": "No residual filling of previously identified right PCA aneurysm ___ year after\npipeline.\n\nSlight stenosis at the origin the bilateral superior cerebellar arteries after\npipeline.\n\nDecreased filling of the left posterior cerebral artery based on the right\nvertebral injection. This is new after pipeline. This is likely compensated\nby a previous fetal configuration to the pcom.\n\nRECOMMENDATION(S):\n1. Follow-up protocol" + }, + { + "input": "There is normal compressibility, flow and augmentation of the left common\nfemoral, superficial femoral, and popliteal veins. Normal color flow and\ncompressibility are demonstrated in the posterior tibial and peroneal veins.\n\nThere is normal respiratory variation in the common femoral veins bilaterally.\n\nNo evidence of medial popliteal fossa (___) cyst.", + "output": "No evidence of deep venous thrombosis in the left lower extremity veins." + }, + { + "input": "Initial limited grayscale ultrasound imaging of the right parotid gland did\nnot demonstrate any significant abnormality, however, upon switching probes to\na lower frequency, a somewhat subtle hypoechoic 1.1 x 1.6 cm lesion seen at\nthe edge of the deep parotid. This lesion was targeted for fine needle\naspiration using a 20 gauge spinal needle due to its deep location.\nApproximately 2 cc of serous cystic fluid were aspirated and and the lesion\ncollapsed was no longer visible with ultrasound. No other lesions were\nidentified.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected in the right side of\nthe neck and the skin was prepped and draped in the usual aseptic fashion. 1%\nlidocaine was instilled for local anesthesia.\n\nThe parotid lesion was targeted for fine needle aspiration using a 20 gauge\nspinal needle due to its deep location. Approximately 2 cc of serous cystic\nfluid were aspirated and and the lesion collapsed was no longer visible with\nultrasound. A sample was given to the on-site cytologist with the remaining\nfluid placed in Cytolyt solution and sent to cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Fine needle aspiration of deep parotid lesion on the right which demonstrated\nserous, cystic fluid and collapsed on aspiration. Samples were sent to\ncytology.\n\nNo prior imaging or reports were available for consultation, therefore if this\nlesion does not correspond to that seen on previous MRI, new imaging or review\nof the outside MRI by ___ is recommended." + }, + { + "input": "Expected postoperative changes are noted within the region of concern\ncorresponding to the patient's surgical scar. No underlying fluid collection\nor mass is detected. No hyperemia is visualized within this region.", + "output": "No evidence of abscess or recurrent mass." + }, + { + "input": "BILATERAL DIGITAL MAMMOGRAM:\n\nTissue density: The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND:\n\nAt the site of the patient's pain, at the 9 o'clock position 18 cm from the\nnipple, there is a prominent blood vessel. No suspicious solid or cystic\nlesion is seen in this site or at the 12 o'clock position, at a second site of\npain as indicated by the patient.", + "output": "No evidence of malignancy. Prominent blood vessel at the site of the patient's\npain at the 9 o'clock position.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure ultrasound demonstrates an anechoic fluid collection in\nthe low anterior abdominal wall at the site of discomfort indicated by the\npatient.", + "output": "US-guided aspiration of 150cc clear, straw-colored fluid from the anterior\nabdominal wall fluid collection, consistent with a seroma." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate to severe heterogeneous\natherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 92 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 182 cm/s, 126 cm/s, and 140 cm/s respectively. The peak\nend diastolic velocity in the right internal carotid artery is 320 cm/sec.\nThe ICA/CCA ratio is 2.0.\nThe external carotid artery has peak systolic velocity of114 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate predominantly calcified\natherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 140 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 158 cm/s, 111 cm/S, and 70 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 329 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "60-69% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "RIGHT:\nThere is moderate heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 84.5 cm/s / 13 cm/s\nCCA Distal: 109 cm/s / 20 cm/s\nICA ___: 166 cm/s / 31.8 cm/s\nICA Mid: 130 cm/s / 25 cm/s\nICA Distal: 85.6 cm/s / 20.5 cm/s\nECA: 234 cm/s\nVertebral: 80.1 cm/s\n\nICA/CCA Ratio: 1.52\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 89 cm/s / 14.8 cm/s\nCCA Distal: 101 cm/s / 16.4 cm/s\nICA ___: 112 cm/s / 22.2 cm/s\nICA Mid: 87.9 cm/s / 19.4 cm/s\nICA Distal: 60.2 cm/s / 17.5 cm/s\nECA: 256 cm/s\nVertebral: 88.1 cm/s\n\nICA/CCA Ratio: 1.11\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 60-69% stenosis.\nLeft ICA 40-59% stenosis.\nThe right is not significantly changed compared to ___. On the left\nvelocities are slightly lower compared to prior study." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque in the proximal\ninternal carotid artery at the bifurcation.\nThe right common carotid artery had peak systolic/diastolic velocities of\n61/15 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n84/15 cm/sec in its proximal portion, 84/22 cm/sec in its mid portion and\n73/29 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 121cm/sec.\nThe vertebral artery has peak systolic velocity of 61 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.3.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque at the carotid\nbifurcation and in the proximal internal carotid artery.\nThe left common carotid artery had peak systolic/diastolic velocities of 92/25\ncm/sec.\nThe left internal carotid artery had peak systolic/diastolic velocities of\n69/25 cm/sec in its proximal portion, 80/33 cm/sec in its mid portion and\n73/25 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 91cm/sec.\nThe vertebral artery has peak systolic velocity of 51 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.8.", + "output": "Less than 40% stenosis of bilateral internal carotid arteries." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is oval 10 mm mass in the lower inner right breast at posterior depth. \nThere is an approximately 18 mm lobulated mass in the lower inner left breast.\nThere are no suspicious grouped calcifications or distortions.\n\nBREAST ULTRASOUND: In the right breast at 5:00 position 5 cm from the nipple\nthere is a 10 x 5 x 8 mm group of cysts, correlating to the oval mass on the\nmammogram. In the left breast at 8:00 position 7 cm from the nipple there is\na 19 x 11 x 5 mm group of cysts, correlating to the lobulated mass on the\nmammogram.", + "output": "Bilateral cluster of cysts including at 5:00 position 5 cm from the nipple on\nthe right breast and at 8:00 position 7 cm from the nipple in the left breast,\ncorrelating to the masses on recent screening mammogram.\n\nRECOMMENDATION(S): Six-month imaging follow-up is recommended for both\nbreasts with diagnostic mammogram and ultrasound to document expected\nstability of the findings.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe 10 mm nodule in the lower inner right breast appears stable. Previously\nidentified nodule in the lower inner left breast has near completely resolved.\nNo new dominant mass, architectural distortion or suspicious\nmicrocalcifications are noted. Left breast is not significantly changed from\n___.\n\nBREAST ULTRASOUND: Evaluation of the lower inner breast was performed\nbilaterally.\nAgain demonstrated at 5 o'clock, 5 cm from the nipple is a cluster of\nmicrocysts spanning 9 mm x 4 mm x 9 mm, unchanged from ___.\nOn the left, at 8 o'clock, 7 cm from the nipple the clustered microcysts have\ndecreased in size currently measuring 9 mm x 3 mm x 11 mm.", + "output": "Probable benign right breast clustered microcysts at 5 o'clock. Interval\ndecrease in size of the clustered microcysts in the left breast.\n\nRECOMMENDATION(S): Followup bilateral diagnostic mammogram and right breast\nultrasound in ___ year is recommended.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe 10 mm nodule in the lower inner right breast appears stable. Previously\nidentified nodule in the lower inner left breast has near completely resolved.\nNo new dominant mass, architectural distortion or suspicious\nmicrocalcifications are noted. Left breast is not significantly changed from\n___.\n\nBREAST ULTRASOUND: Evaluation of the lower inner breast was performed\nbilaterally.\nAgain demonstrated at 5 o'clock, 5 cm from the nipple is a cluster of\nmicrocysts spanning 9 mm x 4 mm x 9 mm, unchanged from ___.\nOn the left, at 8 o'clock, 7 cm from the nipple the clustered microcysts have\ndecreased in size currently measuring 9 mm x 3 mm x 11 mm.", + "output": "Probable benign right breast clustered microcysts at 5 o'clock. Interval\ndecrease in size of the clustered microcysts in the left breast.\n\nRECOMMENDATION(S): Followup bilateral diagnostic mammogram and right breast\nultrasound in ___ year is recommended.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications. Well-circumscribed nodule is again\ndemonstrated in the inner right breast, unchanged from ___ spanning 11\nmm. The left breast appears unchanged from ___.\n\nBREAST ULTRASOUND: The inner right breast was examined in the area previously\nimaged. Again demonstrated at 5 o'clock, 5 cm from the nipple is a cluster of\nmicrocysts spanning 7 mm x 5 mm by 7 mm, slightly decreased in size from prior\nstudies. No dominant vascularity or posterior shadowing is identified.", + "output": "Probable benign right breast nodule at 5 o'clock likely corresponding to\nclustered microcysts.\n\nRECOMMENDATION(S): Additional follow-up diagnostic mammogram and right breast\nultrasound in ___ year is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "There is moderate calcified atherosclerotic plaque.\n\nAortic cross-sections:\nProximal: 2.1 x 2.3 cm\nMid: 1.5 x 1.5 cm\nDistal: 1.3 x 1.2 cm\n\nRight iliac artery: 0.8 x 0.8 cm\nLeft iliac artery: 1.0 x 0.8 cm\n\nThe right kidney measures 10.3 cm. The left kidney measures 10.4 cm. There\nis suggestion of a scar in the upper pole of the left kidney. Kidneys are\notherwise unremarkable in appearance with normal corticomedullary\ndifferentiation and no evidence of hydronephrosis.", + "output": "Aortic atherosclerotic disease without evidence of aneurysm." + }, + { + "input": "The spleen measures 10.1 cm and has homogenous echotexture, with no evidence\nof splenic infract or focal lesions. The splenic vein and artery are patent. \nThere is a moderate-sized left-sided pleural effusion.", + "output": "1. Normal splenic ultrasound with no evidence of splenic infarct or focal\nlesions.\n2. Moderate-sized left-sided pleural effusion." + }, + { + "input": "1. Targeted ultrasound was performed in the right mid abdomen, again\ndemonstrating an omental implant inferior to the liver edge which was palpable\non physical examination, similar to prior ultrasound from ___. This\nsite was targeted for ultrasound-guided biopsy.\n2. Limited preprocedure CT scan demonstrated a large centrally necrotic\nabdominopelvic mass measuring approximately 20 cm, similar to prior study from\n___. The periphery of this lesion was targeted for CT-guided biopsy.", + "output": "1. Successful ultrasound-guided biopsy of omental mass in the right mid\nabdomen. Three core specimens sent in formalin for pathology.\n2. Successful CT-guided biopsy of large pelvic mass. Five core specimens sent\nin formalin for pathology." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: Right upper quadrant\nFluid: 1.25 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology, cytology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.25 L of fluid were removed and sent for analysis." + }, + { + "input": "Successful US-guided placement of ___ pigtail catheter into gallbladder\nfossa collection. Samples were sent for microbiology evaluation.", + "output": "Successful US-guided placement of ___ pigtail catheter into gallbladder\nfossa collection. Samples were sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 110 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 70.4, 71.5, and 68.6 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 30.5 cm/sec.\nThe ICA/CCA ratio is 0.65.\nThe external carotid artery has peak systolic velocity of 87.9 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 105 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 70.7, 62.9, and 69.9 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19.6 cm/sec.\nThe ICA/CCA ratio is 0.67.\nThe external carotid artery has peak systolic velocity of 80.9 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild atherosclerotic plaque bilaterally in the carotid vasculature. No\nhemodynamically significant stenosis bilaterally." + }, + { + "input": "LEFT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: There are scattered areas of fibroglandular density.\nThere is persistent asymmetry seen just inferior to the lumpectomy scar on the\nlateral and the MLO spot view. A corresponding abnormality is not identified\non the original CC image.\n\nLEFT BREAST ULTRASOUND:\n\nThe ultrasound of the left upper breast was performed inferior to the\nlumpectomy scar. There is expected architectural distortion between the 11 and\n1 o'clock. At the site of lumpectomy. Lateral and slightly inferior to the\nscar in the 2 o'clock 4 cm from the nipple there is a hypoechoic circumscribed\nmass which measures 0.6 x 0.2 x 0.6 cm and demonstrates no internal\nvascularity or posterior features.", + "output": "Solid mass in the 2 o'clock left breast.\n\nRECOMMENDATION: A biopsy is recommended uppercase diagnosis. This is amenable\nfor ultrasound guided core biopsy.\n\nNOTIFICATION: Findings the recommendations were discussed with the patient.\nFindings and recommendations were communicated to Dr. ___ email at 16:20\non ___.\n\n\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "2 o'clock, 4 cm from the nipple: There is an oval-shaped hyperechoic\nbenign-appearing mass measuring 6 mm x 6 mm. This is the target for\nultrasound-guided core biopsy\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\n\nSpecimens: Sent to Pathology.\nAnesthesia: Buffered 1% lidocaine\nComplications: None\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.\nStandard post care instructions were provided to the patient.", + "output": "Successful ultrasound guided biopsy." + }, + { + "input": "2 o'clock, 4 cm from the nipple: There is an oval-shaped hyperechoic\nbenign-appearing mass measuring 6 mm x 6 mm. This is the target for\nultrasound-guided core biopsy\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\n\nSpecimens: Sent to Pathology.\nAnesthesia: Buffered 1% lidocaine\nComplications: None\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.\nStandard post care instructions were provided to the patient.", + "output": "Successful ultrasound guided biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 5 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 3.5 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.5 L of serosanguinous fluid were removed." + }, + { + "input": "Static images provided by the ultrasound technologist about the tibiotalar\njoint reviewed.\n\nThere is a moderate tibiotalar joint effusion distending the anterior recess,\nwith synovial proliferation and hyperemia, in keeping with active synovitis. \nThere are few low level echoes within this, without comet tail artifact, may\nrepresent debris rather than tiny crystals. There are no periarticular soft\ntissue masses or calcifications, suspicious for tophi, or subjacent erosions.\n\nReview of images labeled as the medial ankle, there is probable flexor\ntendinopathy.", + "output": "Tibiotalar joint effusion confirmed, with Findings of active synovitis. There\nare no definite tophi or juxta-articular erosions, suspicious for gout." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 1.254 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.254 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the midline\ninfraumbilical region was selected for paracentesis.\n\nPROCEDURE: Ultrasound-guided diagnostic paracentesis\nLocation: Midline infraumbilical\nFluid: 10 cc of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 20 gauge spinal needle advanced into the\nlargest fluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound-guided diagnostic paracentesis.\n2. 10 cc of fluid were removed and sent for requested analysis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 65 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 40, 58, and 6 to cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.93.\nThe external carotid artery has peak systolic velocity of 94 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 44, 70, and 45 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.8 set.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Findings consistent with less than 40% ICA stenosis bilaterally." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA BB marker is placed over the upper outer posterior left breast in the area\nof concern as indicated by the patient. This area is somewhat suboptimally\nevaluated due to the presence of the implant but no corresponding abnormality\nis seen mammographically. Ultrasound was performed for further evaluation. \nBilateral silicone implants are noted, unchanged in contour. There is no\nsuspicious mass, suspicious grouped microcalcifications or architectural\ndistortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of concern\nas indicated by the patient, though she was unable to find the exact area\nwhich she had previously felt. No suspicious solid or cystic mass was\nidentified from ___ o'clock 8 cm from the nipple.", + "output": "1. No mammographic or sonographic correlate for the area of concern as\nindicated by the patient. Clinical follow-up is recommended. Any decision to\nbiopsy should be based on clinical assessment.\n2. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Clinical followup for left breast area of concern. Annual\nscreening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\nBREAST ULTRASOUND: Targeted examination to the symptomatic area in the right\nbreast shows heterogeneous appearing fibroglandular tissue with no mass or\nshadowing abnormality.", + "output": "No mammographic findings to indicate malignancy. There is no mammographic or\nultrasound abnormality in the region of current symptomatology on the right.\n\nRECOMMENDATION: Clinical followup if symptoms persist.\n\nNOTIFICATION: Findings and above recommendation reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "1. Redemonstration of a cluster of prominent lymph nodes in the left groin.\n2. Successful core needle biopsy and fine needle aspiration of the largest\ninguinal node. The samples were sent to pathology for evaluation.", + "output": "Successful core needle biopsy and fine needle aspiration of the largest left\ninguinal node. The samples were sent to pathology for evaluation." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the porta\nhepatis was performed. A 4.7 cm enlarged lymph node in the anterior aspect of\nthe porta hepatis just deep to the anterior abdominal wall was identified for\nbiopsy after review of the same-day CT. A suitable approach for targeted\nbiopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the enlarged\nlymph node were anesthetized with 12 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a 17-gauge coaxial needle was advanced to\nthe target lesion. Through this needle, 6 x 18-gauge core biopsy passes were\nperformed. The samples were submitted for lymphoma protocol.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 24\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted lymph node biopsy x 6, with specimen sent for\nlymphoma protocol." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nA BB marker is placed in the upper outer right breast in the area of concern. \nNo underlying mammographic abnormality is identified. There are bilateral\ndiffuse calcifications consistent with a benign process. There is no\nsuspicious dominant mass, unexplained architectural distortion or suspicious\ngrouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast in\nthe area of concern at 10 o'clock 1-8 cm from the nipple. No suspicious solid\nor cystic mass was identified. Lactational changes are noted in this area.", + "output": "1. No suspicious findings in the right breast in the area of concern. \nClinical follow-up is recommended.\n2. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Clinical follow-up for right breast lump. Age and risk\nappropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Transabdominal ultrasound guidance was provided for Dr. ___\nhysteroscopy and polypectomy. A partial false passage is demonstrated post\ninstrumentation in the fundal portion of the left cavity. There is no free\nfluid in the cul-de-sac. A total of 29 images were obtained.", + "output": "Intraoperative ultrasound guidance was provided." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 72, 75, and 86 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 130 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 102 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 96, 80, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 45 cm/sec.\nThe ICA/CCA ratio is 0.94.\nThe external carotid artery has peak systolic velocity of 77 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous plaque involving the ostium of both internal carotid\narteries.\n\nNo evidence of hemodynamic stenoses on either side (Less than 40%).\n\nNormal antegrade flow both vertebral arteries." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications. Right CC view was repeated with no motion\non the repeat image. No suspicious abnormalities are seen in the right\nbreast.\nAn asymmetry in the upper-outer left breast is pliable on additional views,\nmost consistent with normal overlapped breast tissue. There is an 8 mm\ncircumscribed reniform oval circumscribed mass with circumscribed margins with\na fatty hilum, consistent with an intramammary lymph node.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper-outer left breast was\nperformed revealing no suspicious solid or cystic masses. Normal appearing\nbreast tissue is seen.", + "output": "There is a probably benign asymmetry in the upper-outer left breast for which\nsix-month follow-up mammogram is recommended to document stability.\n\nRECOMMENDATION(S): Diagnostic mammogram of left breast in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\n\nLeft breast: Asymmetry in the upper outer left breast, most likely\nrepresenting overlapping breast tissue, demonstrate six-month stability,\nprobably benign. There is no suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed in\nthe area of tenderness as indicated by the patient.\nIn the left breast at ___ o'clock 1-5 cm from the nipple, no sonographic\nabnormalities are detected.", + "output": "1. Six-month stability of a probably benign left breast asymmetry for which\nsix-month follow-up is recommended to assess stability.\n2. No sonographic abnormalities in the area of pain in the left breast. \nPatient denies feeling any palpable abnormalities at the time of this\nexamination.\n\nRECOMMENDATION(S):\n1. Six-month follow-up diagnostic left mammogram.\n2. Clinical follow-up for left breast pain.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\n\nLeft breast: Asymmetry in the upper outer left breast, most likely\nrepresenting overlapping breast tissue, demonstrate six-month stability,\nprobably benign. There is no suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed in\nthe area of tenderness as indicated by the patient.\nIn the left breast at ___ o'clock 1-5 cm from the nipple, no sonographic\nabnormalities are detected.", + "output": "1. Six-month stability of a probably benign left breast asymmetry for which\nsix-month follow-up is recommended to assess stability.\n2. No sonographic abnormalities in the area of pain in the left breast. \nPatient denies feeling any palpable abnormalities at the time of this\nexamination.\n\nRECOMMENDATION(S):\n1. Six-month follow-up diagnostic left mammogram.\n2. Clinical follow-up for left breast pain.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "The aorta measures 1.8 cm in the proximal portion, 1.8 cm in mid portion and\n1.8 cm in the distal abdominal aorta. There is minimal atherosclerotic\nplaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.1 cm and the left common iliac artery\nmeasures 1.5 cm.\n\nThe right kidney measures 10.5 cm and the left kidney measures 10.5 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.\n\nThe partially imaged liver is echogenic.", + "output": "1. No evidence of abdominal aortic aneurysm.\n\n2. Echogenic liver consistent with steatosis. Other forms of liver disease\nand more advanced liver disease including steatohepatitis or significant\nhepatic fibrosis/cirrhosis cannot be excluded on this study." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin the right carotid bulb/proximal right ICA.\nThe peak systolic velocity in the right common carotid artery is 52 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 54, 63, and 51 cm/sec, respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 46 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin the left carotid bulb and proximal right ICA.\nThe peak systolic velocity in the left common carotid artery is 67 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 58, 71, and 66 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 38 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild bilateral mixed plaque carotid atherosclerosis within the proximal\nbilateral ICAs resulting in estimated stenosis of less than 40%." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nStable postsurgical changes within the upper outer right breast. \nMagnification views again demonstrate unchanged faint calcifications in the\nmedial inferior aspect of the lumpectomy bed along with additional scattered\npunctate calcifications unchanged from ___. Additional stable punctate\ncalcifications scattered throughout the left breast. There is no dominant\nmass, unexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at 7 o'clock left breast\n4 cm from nipple which was site of pain as denoted by the patient and which\nwas without any discrete suspicious solid or cystic masses.", + "output": "No mammographic evidence of malignancy within either breast.\n\nApproximately ___ year stability of residual calcifications in surgical bed\nupper outer right breast.\n\nNo mammographic or sonographic findings to account for focal left breast pain.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nClinical follow-up left breast symptoms.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 37, 52, and 45 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.71.\nThe external carotid artery has peak systolic velocity of 80 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 54, 47, and 71 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 0.2 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 87 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No atherosclerosis or hemodynamically significant stenosis of the bilateral\ncarotid arteries." + }, + { + "input": "The liver appears echogenic which may reflect steatosis. No discrete focal\nliver lesion is seen. Main portal vein is patent demonstrating hepatopetal\nflow. The IVC appears patent. No abdominal ascites is seen. The gallbladder\nis moderately distended containing a several mole bile gallstones. The\nsonographic ___ sign is not elicited. No signs of gallbladder wall\nthickening or pericholecystic fluid. The common bile duct is mildly prominent\nmeasuring 6 mm in diameter. No signs of choledocholithiasis. Limited views\nof both kidneys appear normal. The spleen is within normal limits of size. \nThe pancreas is grossly unremarkable.", + "output": "1. Echogenic liver which could reflect fatty deposition. Please note based on\nthis appearance more dense forms of liver disease cannot be excluded.\n2. Cholelithiasis with moderately distended gallbladder and negative ___\nsign. Top normal CBD diameter, difficult to exclude distal CBD stone.\n\nNOTIFICATION: D/W Dr. ___ at the time of initial review." + }, + { + "input": "Targeted ultrasound 10 o'clock right breast 1-2 cm from the nipple and 7 cm\nfrom the nipple performed to cover area of concern as indicated by the patient\nat the time of examination as well the area indicated on the order requisition\nwhich was without suspicious cystic or solid mass identified.", + "output": "No sonographic Findings to account for patient's right breast symptoms for\nwhich clinical follow-up is recommended.\n\nRECOMMENDATION(S): Clinical follow-up area of concern right breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The gallbladder was the a moderately distended with wall thickening and edema.\nThere is cholelithiasis. Findings are compatible with acute cholecystitis.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 55, 53, and 50 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 13 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 80 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 57, 68, and 53 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 47 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis of the right ICA.\n\nLess than 40% stenosis of the left ICA." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 77, 93, and 77 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 145 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 80, 59, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 128 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous atherosclerotic plaque in both internal carotid arteries,\nwith less than 40% stenosis of each internal carotid artery." + }, + { + "input": "In the left breast at 3 o'clock 3 cm from the nipple is an irregular\nhypoechoic mass which was targeted for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by T. ___,\nM.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous HydroMark coil clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending. The patient has requested to hear the pathology results from\n___, NP who will contact the patient in ___ business days. \nStandard post care instructions were provided to the patient." + }, + { + "input": "In the left breast at 3 o'clock 3 cm from the nipple is an irregular\nhypoechoic mass which was targeted for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by T. ___,\nM.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous HydroMark coil clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending. The patient has requested to hear the pathology results from\n___, NP who will contact the patient in ___ business days. \nStandard post care instructions were provided to the patient." + }, + { + "input": "The skin is normal. There is no interruption of the normal subcutaneous\ntissues or muscular planes. No adenopathy is seen", + "output": "Normal\n\nRECOMMENDATION(S): Clinical follow-up\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Abnormal appearance of the right biceps muscle with abnormal hypoechoic\nechotexture, correlating to the PET-CT abnormality, demonstrating increased\nvascularity.", + "output": "1. Infiltrative lesion within the right biceps muscle corresponding to the\nPET-CT abnormality.\n2. Technically successful ultrasound-guided percutaneous biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nOf note, multiple subtly hypoechoic masses are seen seen throughout the liver.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.5 L of fluid was removed." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: There are scattered areas of fibroglandular density. An\novoid circumscribed mass in the mid depth quadrant is stable in appearance\nsince ___.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nLEFT BREAST ULTRASOUND:\n\nComparison is made to prior ultrasound from in ___ and ___.\nThe left upper inner quadrant was scanned . There is a solid hypoechoic ovoid\nwell-circumscribed mass in the ___ o'clock 6 cm from the nipple. This\nmeasures 0.7 x 0.4 x 0.7 cm and demonstrates no internal vascularity or\nposterior features. This is sonographically stable in appearance since ___.", + "output": "One year stability of probable benign left breast mass. Further ___ year\nfollowup left breast ultrasound as well as left diagnostic mammogram is\nrecommended to assess continued stability. At that time patient will be due\nannual mammography of right breast.\n\nRECOMMENDATION: ___ year followup bilateral diagnostic mammogram and left\nbreast ultrasound.\n\nNOTIFICATION: Findings and recommendations were discussed with the patient.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is a focal asymmetry in slightly medial upper left breast, unchanged\nsince ___ exam. There is no spiculated mass, architectural distortion\nor suspicious grouped microcalcifications in either breast. Bilateral\nrod-like calcifications, are likely secretory nature.\n\nBREAST ULTRASOUND:\nTargeted ultrasound exam of the left breast was performed. At 11 o'clock\nposition, 6 cm from nipple, there is a 0.6 x 0.4 x 0.7 cm oval hypoechoic mass\nwith circumscribed margins and no internal vascularity. It is unchanged in\nsize and characteristics since ___ exam.", + "output": "Two year stability of left breast focal asymmetry and probably benign left\nbreast mass on ultrasound, for which ___ year followup is recommended to ensure\nstability.\n\nRECOMMENDATION: Bilateral diagnostic mammography and left breast ultrasound\nin ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is an oval mass in the medial left breast which is slightly increased in\nsize and density when compared to prior studies dating to ___. Otherwise,\nthere is no suspicious mass, unexplained architectural distortion or grouped\nmicrocalcification. Vascular and secretory calcifications are again noted.\n\nBREAST ULTRASOUND: At the 11 o'clock position of the left breast 6 cm from\nthe nipple, there is an 11 x 7 x 4 mm oval hypoechoic mass which is increased\nin size compared to the prior study.", + "output": "Enlarging left breast mass is suspicious.\n\nNo specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the left breast mass with\ninterpretation services present.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient via\ninterpreter who agrees with the plan. Findings and recommendation submitted\nvia the radiology critical results communication system to Dr. ___ at 11:25\n___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "There is an oval hypoechoic mass in the left breast measuring 7 x 4 x 9 mm at\n11 o'clock, 6 cm from the nipple, which was targeted for ultrasound-guided\ncore biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, DO. The procedure was supervised by ___,\nM.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate ribbon clip\nplacement. No significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the left breast mass at 11:00\n. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "There is an oval hypoechoic mass in the left breast measuring 7 x 4 x 9 mm at\n11 o'clock, 6 cm from the nipple, which was targeted for ultrasound-guided\ncore biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, DO. The procedure was supervised by ___,\nM.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate ribbon clip\nplacement. No significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the left breast mass at 11:00\n. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 110 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 63, 62, and 75 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.68.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 64, 79, and 71 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.91.\nThe external carotid artery has peak systolic velocity of 81 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the right and left internal carotid arteries." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated\nmoderateascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of clear, red -colored fluid was removed. The samples\nwere sent for microbiology, cell count and cytology.\n\nThe patient tolerated the procedure well until the full 2 L have been\nobtained, at which point the patient developed significant nausea, therefore,\nthe procedure was terminated. Estimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic and diagnostic\nparacentesis" + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 20\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "2.3 x 2.9 cm solid hypoechoic mass within the left submandibular region with\ninternal vascularity, anterior to the left submandibular gland.", + "output": "Technically successful core needle biopsy of left neck mass. 6 samples (18\ngauge, 22 mm cores) were submitted for pathology, 2x in formalin and 2x in\neach of two separate RPMI containers for flow and cytogenetics. No immediate\npostprocedure complication." + }, + { + "input": "Heterogeneously hypoechoic mass at the left nasolabial fold.", + "output": "Technically successful ultrasound-guided FNA of mass at the left nasal labial\nfold." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe asymmetry in the left medial breast is pliable on spot compression views\nand not seen on the CC view obtained today, consistent with summationof\ntissues.\nGiven dense breast, Ultrasound evaluation was performed.\n\nLEFT BREAST ULTRASOUND: The entire left inferior medial breast was scanned. A\nfew cysts noted in the left breast at 8:30, 4-5 cm in the nipple and at 7\no'clock 7 cm from the nipple. No discrete solid lesion of concern.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Annual mammography\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 11\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. An ill-defined heterogeneous hypoechoic area was identified in\ninferior right lobe. A suitable approach for targeted liver biopsy was\ndetermined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a single 18-gauge core biopsy sample was\nobtained. The sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: No sedation was given.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 1, with specimen sent to\npathology." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 1.1 L of serosanguinous fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 1.1 L of fluid were removed." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\n\nAgain seen is a approximately 3.9 cm round well-circumscribed mass in the left\nbreast, unchanged since ___.\n\nBenign-appearing scattered bilateral calcifications are also stable. There are\nno new suspicious findings in either breast. Specifically, no spiculated\nmasses, suspicious clustered microcalcifications or areas of architectural\ndistortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. In\nthe left breast at 3 o'clock position in the retroareolar region there is a\n2.9 x 2.8 cm oval parallel circumscribed mixed echogenicity predominantly\nisoechoic mass, likely corresponding to a hamartoma on mammography.\nAdditionally, at 3 o'clock position 0-1 cm from the nipple there is a\nhypoechoic oval parallel circumscribed lesion measuring 7 x 4 x 7 mm, composed\nof multiple small cysts. There is no internal vascularity. This smaller lesion\nis stable since ___.", + "output": "1. No new suspicious mammographic findings. Benign approximately 3.9 cm mass\nin the left subareolar breast likely represents a hematoma and has been stable\nsince ___. Benign bilateral scattered calcifications are also stable.\n\n2. ___ year stability of a likely benign hypoechoic mass, likely representing\ncluster of small cysts in the 3 o'clock position 0-1 cm from the nipple.\nContinued followup in ___ year with ultrasound of the time of annual mammography\nto document greater than ___ years of stability is recommended.\n\nRECOMMENDATION: Continued sonographic followup of a likely benign lesion in\nthe left breast in ___ year at the time of her annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\n\nAgain seen is a approximately 3.9 cm round well-circumscribed mass in the left\nbreast, unchanged since ___.\n\nBenign-appearing scattered bilateral calcifications are also stable. There are\nno new suspicious findings in either breast. Specifically, no spiculated\nmasses, suspicious clustered microcalcifications or areas of architectural\ndistortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. In\nthe left breast at 3 o'clock position in the retroareolar region there is a\n2.9 x 2.8 cm oval parallel circumscribed mixed echogenicity predominantly\nisoechoic mass, likely corresponding to a hamartoma on mammography.\nAdditionally, at 3 o'clock position 0-1 cm from the nipple there is a\nhypoechoic oval parallel circumscribed lesion measuring 7 x 4 x 7 mm, composed\nof multiple small cysts. There is no internal vascularity. This smaller lesion\nis stable since ___.", + "output": "1. No new suspicious mammographic findings. Benign approximately 3.9 cm mass\nin the left subareolar breast likely represents a hematoma and has been stable\nsince ___. Benign bilateral scattered calcifications are also stable.\n\n2. ___ year stability of a likely benign hypoechoic mass, likely representing\ncluster of small cysts in the 3 o'clock position 0-1 cm from the nipple.\nContinued followup in ___ year with ultrasound of the time of annual mammography\nto document greater than ___ years of stability is recommended.\n\nRECOMMENDATION: Continued sonographic followup of a likely benign lesion in\nthe left breast in ___ year at the time of her annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of 60\ncm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n61/16 cm/sec in its proximal portion, 59/15 cm/sec in its mid portion and\n56/16 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 77cm/sec.\nThe vertebral artery has peak systolic velocity of 46/13 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.0.\n\nLEFT:\nThe leftcarotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left common carotid artery had peak systolic/diastolic velocities of 65\ncm/sec.\nThe left internal carotid artery had peaks ystolic/diastolic velocities of\n___ cm/sec in its proximal portion, 47/15 cm/sec in its mid portion and\n48/17 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 65cm/sec.\nThe vertebral artery has peak systolic velocity of 29 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.7.", + "output": "Mild atherosclerotic disease in both carotid arteries causing no significant\nstenosis." + }, + { + "input": "There is redemonstration of the fluid collection superficial and slightly to\nthe right of the pubic symphysis. This was targeted for aspiration.", + "output": "Successful US-guided aspiration of the superficial pubic symphysis fluid\ncollection. A sample was sent for microbiology evaluation." + }, + { + "input": "RIGHT BREAST ULTRASOUND : Targeted ultrasound of the right breast was\nperformed. In the right breast at 4 o'clock 7 cm from the nipple is a\nwell-circumscribed ovoid hypoechoic lesion measuring 0.6 x 0.3 x 0.7 cm which\nshows some posterior acoustic enhancement and some peripheral vascularity.\nThis most likely represents a fibroadenoma and is stable for ___ year.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast was performed.\nIn the left breast at 12: 30, 7 cm from the nipple is a well-circumscribed,\noval, hypoechoic lesion measuring 1.2 x 0.4 x 1 cm. This shows some\nperipheral vascularity and these are stable since ___.", + "output": "Bilateral probable benign masses as described. These most likely represent\nfibroadenomas and given stability for ___ year followup ultrasound is\nrecommended in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Right breast: Targeted ultrasound in the area of focal pain in the\nupper-outer right breast was performed. There are no suspicious cystic or\nsolid masses identified to correlate with breast pain. In the 4 o'clock\nposition 7 cm from the nipple again seen is an oval parallel circumscribed\nhypoechoic mass measuring 7 x 3 x 8 mm, similar to prior measurements of 7 x 6\nx 3 mm, given difference in technique.\n\nLeft breast: In the 12:30 o'clock position 7 cm from the nipple again seen is\nan oval parallel well-circumscribed hypoechoic mass measuring 1.1 x 0.9 x 0.5\ncm, similar to prior measurement of 1.1 x 0.3 x 0.9 cm. Targeted ultrasound\nof the left axilla was performed, revealing normal appearing axillary lymph\nnodes. No suspicious cystic or solid masses are seen.", + "output": "___ year stability of bilateral probably benign masses. Additional ___ year\nfollow-up is recommended to document stability. No suspicious sonographic\nabnormalities in the area of focal pain in the upper-outer right breast or in\nthe area of palpable lump in the left axilla.\n\nRECOMMENDATION(S): Clinical followup for breast pain and palpable lump. \nFinal patient disposition and any decision to biopsy should be based on\nclinical assessment. Additional ___ year sonographic followup of probably\nbenign masses bilaterally.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the right breast at 4 o'clock, 7 cm from the nipple, no suspicious solid or\ncystic masses were identified. In the left breast between 1 and 2 o'clock, 7\ncm from nipple, no suspicious solid or cystic masses were identified.", + "output": "No sonographic evidence of malignancy in the areas of previously described\nprobably benign masses.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "SPLEEN: Normal echogenicity, measuring 12.6 cm.", + "output": "Normal spleen ultrasound." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography. The bilateral breasts have the appearance of a\nlactating patient.\n\nAsymmetrical breast tissue is seen extending into the right axilla, similar to\nfindings on same day right breast ultrasound. This area correlates to a\npalpable marker placed in the area of palpable concern in the axillary tail of\nthe right breast. Biopsy clip in the upper outer left breast is again noted. \nGlobal asymmetry of the central mid right breast at the 12 o'clock position\nwas further evaluated on same day ultrasound. Prominent bilateral axillary\nlymph nodes were also evaluated on same day ultrasound. Otherwise, there is\nno distortion, dominant mass or suspicious grouped calcifications in either\nbreast.\n\nBREAST ULTRASOUND: Targeted right breast axillary ultrasound was performed in\nthe area of palpable concern by the referring physician. In the right axilla\nthere is a 1.5 x 0.5 x 0.8 cm well-circumscribed, avascular anechoic mass most\nconsistent with a cyst. Accessory breast tissue is also seen in the right\naxilla. Normal breast parenchyma is noted in the area of patient's tenderness\nand palpable area of concern at the 10 o'clock position 11 cm from the nipple.\nNo suspicious solid or cystic masses are identified. Physical exam of the\narea of palpable concern by Dr. ___ no suspicious palpable\nabnormalities.\n\nIn the area mammographic asymmetry at the 12 o'clock position, no suspicious\nsolid or cystic masses are identified. Normal breast tissue seen. \nMorphologically normal bilateral axillary lymph nodes are demonstrated.", + "output": "1. Benign-appearing right axillary cyst. Clinical follow-up is recommended. \nAny decision to biopsy should be based on clinical assessment.\n2. Accessory breast tissue in the right axilla.\n3. Normal-appearing breast tissue in the axillary tail of the right breast in\nthe area of palpable concern and tenderness by the patient. Any decision to\nbiopsy should be based on clinical assessment.\n4. No specific mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening. Clinical follow-up of\nthe areas of palpable concern in the right axilla and right breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography. The bilateral breasts have the appearance of a\nlactating patient.\n\nAsymmetrical breast tissue is seen extending into the right axilla, similar to\nfindings on same day right breast ultrasound. This area correlates to a\npalpable marker placed in the area of palpable concern in the axillary tail of\nthe right breast. Biopsy clip in the upper outer left breast is again noted. \nGlobal asymmetry of the central mid right breast at the 12 o'clock position\nwas further evaluated on same day ultrasound. Prominent bilateral axillary\nlymph nodes were also evaluated on same day ultrasound. Otherwise, there is\nno distortion, dominant mass or suspicious grouped calcifications in either\nbreast.\n\nBREAST ULTRASOUND: Targeted right breast axillary ultrasound was performed in\nthe area of palpable concern by the referring physician. In the right axilla\nthere is a 1.5 x 0.5 x 0.8 cm well-circumscribed, avascular anechoic mass most\nconsistent with a cyst. Accessory breast tissue is also seen in the right\naxilla. Normal breast parenchyma is noted in the area of patient's tenderness\nand palpable area of concern at the 10 o'clock position 11 cm from the nipple.\nNo suspicious solid or cystic masses are identified. Physical exam of the\narea of palpable concern by Dr. ___ no suspicious palpable\nabnormalities.\n\nIn the area mammographic asymmetry at the 12 o'clock position, no suspicious\nsolid or cystic masses are identified. Normal breast tissue seen. \nMorphologically normal bilateral axillary lymph nodes are demonstrated.", + "output": "1. Benign-appearing right axillary cyst. Clinical follow-up is recommended. \nAny decision to biopsy should be based on clinical assessment.\n2. Accessory breast tissue in the right axilla.\n3. Normal-appearing breast tissue in the axillary tail of the right breast in\nthe area of palpable concern and tenderness by the patient. Any decision to\nbiopsy should be based on clinical assessment.\n4. No specific mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening. Clinical follow-up of\nthe areas of palpable concern in the right axilla and right breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the left breast in the retroareolar region 0-5 cm from\nthe nipple demonstrates no solid or cystic masses. No abnormality was\nidentified.\n\nTargeted ultrasound of the upper central left breast was performed in the area\nof the mammographic calcifications. At the 12:00 position 8 cm from the\nnipple demonstrates there is a circumscribed echogenic mass with posterior\nacoustic shadowing measuring 0.6 x 0.4 x 0.6 cm, likely representing a benign\nfinding such as fat necrosis which may correspond to a stable low-density\ncircumscribed mass or an adjacent partial rim calcified oil cyst on\nmammography. No sonographic correlate for the calcifications was identified\non ultrasound. No suspect solid mass was identified.", + "output": "1. No sonographic abnormality identified in the retroareolar region to\nexplain nodularity as palpated by healthcare provider. Clinical follow up is\nadvised. Any decision to biopsy should be based on clinical assessment.\n\n2. No sonographic abnormality in the expected area of calcifications present\non prior mammogram dated ___. Given suspicious nature of the\ncalcifications, repeat diagnostic mammogram and stereotactic core needle\nbiopsy is recommended. This was discussed with the patient who declined any\nadditional mammograms were intervention.\n\nRECOMMENDATION(S): 1. Clinical followup for retroareolar nodularity.\n2. Stereotactic core biopsy of the left breast calcifications\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "The visualized portions of the medial compartment tendons appear intact and\nare normal in echogenicity. No space-occupying lesion is noted within the\ntarsal tunnel.\n\nThe Achilles tendon is intact and normal in echogenicity.\n\nLimited evaluation of the plantar fascia demonstrates no gross abnormality.\n\nNo ganglion cyst is seen.\n\nThe subcutaneous soft tissues are unremarkable.", + "output": "Unremarkable exam as above." + }, + { + "input": "Targeted ultrasound at 6 o'clock 6 cm from nipple demonstrated a small ovoid\ncyst measuring 0.4 x 0.2 x 0.3 cm corresponding to the mammographic finding. \nNo solid or shadowing findings are identified.", + "output": "Tiny benign cyst corresponding to the mammographic finding.\n\nRECOMMENDATION(S): Risk and age based screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAdditional imaging demonstrates persistence of the 11 x 5 mm circumscribed\nmass in the upper outer quadrant at mid-posterior depth. There are no\nassociated microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 11 o'clock 8-9\ncm from the nipple demonstrates an oval bilobed circumscribed 11 x 4 mm\nhypoechoic mass, without dominant vascularity or significant posterior\nfeatures. There appears to be some echogenic material in the hypoechoic\nregion which may represent fat. The lesion may represent an intramammary\nlymph node or other benign entity.", + "output": "11 x 4 mm hypoechoic right breast mass at 11 o'clock. As this was the\npatient's initial mammographic evaluation, the age of this lesion is\nundetermined. Consideration should be given to biopsy for definitive\npathology. Alternatively, six-month followup mammogram and ultrasound could\nbe performed.\n\nRECOMMENDATION(S): Right breast ultrasound-guided core biopsy for definitive\npathology.\n\nNOTIFICATION: The finding and options of ultrasound guided biopsy versus\nfollowup were reviewed with the patient. At this time she prefers definitive\npathology. She was given information to schedule a biopsy appointment.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAdditional imaging demonstrates persistence of the 11 x 5 mm circumscribed\nmass in the upper outer quadrant at mid-posterior depth. There are no\nassociated microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 11 o'clock 8-9\ncm from the nipple demonstrates an oval bilobed circumscribed 11 x 4 mm\nhypoechoic mass, without dominant vascularity or significant posterior\nfeatures. There appears to be some echogenic material in the hypoechoic\nregion which may represent fat. The lesion may represent an intramammary\nlymph node or other benign entity.", + "output": "11 x 4 mm hypoechoic right breast mass at 11 o'clock. As this was the\npatient's initial mammographic evaluation, the age of this lesion is\nundetermined. Consideration should be given to biopsy for definitive\npathology. Alternatively, six-month followup mammogram and ultrasound could\nbe performed.\n\nRECOMMENDATION(S): Right breast ultrasound-guided core biopsy for definitive\npathology.\n\nNOTIFICATION: The finding and options of ultrasound guided biopsy versus\nfollowup were reviewed with the patient. At this time she prefers definitive\npathology. She was given information to schedule a biopsy appointment.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Preprocedure ultrasound again demonstrates an oval 11 x 5 mm hypoechoic mass\nwhich is without dominant vascularity, at 11 o'clock 8-9 cm from the nipple. \nThis was the target for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: 8 cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm the clip within the\nmammographic finding.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Preprocedure ultrasound again demonstrates an oval 11 x 5 mm hypoechoic mass\nwhich is without dominant vascularity, at 11 o'clock 8-9 cm from the nipple. \nThis was the target for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: 8 cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm the clip within the\nmammographic finding.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe left breast is without dominant mass, architectural distortion or\nsuspicious grouped calcification. In particular there is no discrete\nabnormality seen at the triangle marker.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left inferior breast at 5\no'clock, 0-12 cm from the nipple was performed. At the patient's area of\nclinical concern, there is normal scattered fibroglandular tissue without\nsuspicious solid or cystic mass.", + "output": "No evidence of malignancy in the left breast.\n\nRECOMMENDATION(S): Annual screening, ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications on either breast.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed over the area of\npain in the left breast 4 o'clock 10 cm from nipple, which was without any\ndiscrete suspicious solid or cystic masses.", + "output": "No evidence of malignancy in bilateral breasts. No focal finding to explain\npatient's pain is identified.\n\nRECOMMENDATION(S): Return to screening. Clinical follow-up for left breast\npain.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Left breast: I scanned the entire breast per patient request including the 12\no'clock region where she feels a general thickening with negative results. No\ncystic, solid or shadowing abnormalities are identified.\n\nRight breast: The patient was unable to identify a lump on the right side at\nthe time of the examination. I scanned the entire right breast per patient\nrequest with negative results. No cystic, solid or shadowing findings were\nnoted.", + "output": "Negative bilateral ultrasound.\n\nRECOMMENDATION(S): Continued clinical evaluation of the patient's bilateral\nbreast pain and lumps recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is focal asymmetry within the upper outer left breast anterior depth\nwith associated faint and pleomorphic calcifications which appear to\ncorrespond to partially obscured tubular structure suggestive of a dilated\nduct. Additionally on the full CC and MLO views there is possible focal area\nof architectural distortion which is somewhat pliable on spot compression\nviews of this area. Ultrasound was performed for further evaluation of these\nfindings. An 0.5 cm asymmetry in the upper breast posterior to the focal\nasymmetry appears pliable on spot compression views likely superimposed\nfibroglandular tissue.\n\nSkin markers in place delineating patient's reduction surgical scar. \nRadiopaque BB placed at site of palpable abnormality upper outer left breast\nposterior depth which is remote from the focal asymmetry and calcifications. \nThere is no underlying mammographic abnormality in this area..\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of pain as\nindicated by the patient at the at 2 o'clock 10-18 cm from the nipple. No\nsuspicious solid or cystic mass was identified.\n\nTargeted ultrasound was performed in the area of the mammographic abnormality.\nAt the 2 o'clock position left breast 2 cm from the nipple demonstrates there\nis a focal area of dilated ducts which contain debris and echogenic foci\nconsistent with calcifications. This area spans at least 2.0 x 0.9 x 1.1 cm. \nDilated ducts containing internal debris and microcalcifications. A simple\ncyst is noted in this area measuring 0.5 x 0.5 x 0.4 cm. Additionally at 1\no'clock in the retroareolar area there is a 0.4 x 0.3 x 0.4 cm hypoechoic mass\nwhich may represent a complicated cyst. This is in continuity with the focal\narea of dilated ducts.", + "output": "1. Dilated ducts with suspicious calcifications at the 2 o'clock position. \nUltrasound-guided biopsy of this area, possibly with vacuum assistance, is\nrecommended. Given that the focal architectural distortion appears to be in\nthis same area, management of that finding will be based on the biopsy\nresults.\n2. No mammographic or ultrasound findings to account for focal pain left\nbreast.\n3. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of dilated ducts with associated\ncalcifications is recommended. Additionally an addendum will be issued once\nprior imaging is available for comparison.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient via an interpreter who agrees with this plan. She was given\ninformation to schedule her biopsy. An e-mail was also sent to the ordering\nprovider ___ at 17:00 ___.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is focal asymmetry within the upper outer left breast anterior depth\nwith associated faint and pleomorphic calcifications which appear to\ncorrespond to partially obscured tubular structure suggestive of a dilated\nduct. Additionally on the full CC and MLO views there is possible focal area\nof architectural distortion which is somewhat pliable on spot compression\nviews of this area. Ultrasound was performed for further evaluation of these\nfindings. An 0.5 cm asymmetry in the upper breast posterior to the focal\nasymmetry appears pliable on spot compression views likely superimposed\nfibroglandular tissue.\n\nSkin markers in place delineating patient's reduction surgical scar. \nRadiopaque BB placed at site of palpable abnormality upper outer left breast\nposterior depth which is remote from the focal asymmetry and calcifications. \nThere is no underlying mammographic abnormality in this area..\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of pain as\nindicated by the patient at the at 2 o'clock 10-18 cm from the nipple. No\nsuspicious solid or cystic mass was identified.\n\nTargeted ultrasound was performed in the area of the mammographic abnormality.\nAt the 2 o'clock position left breast 2 cm from the nipple demonstrates there\nis a focal area of dilated ducts which contain debris and echogenic foci\nconsistent with calcifications. This area spans at least 2.0 x 0.9 x 1.1 cm. \nDilated ducts containing internal debris and microcalcifications. A simple\ncyst is noted in this area measuring 0.5 x 0.5 x 0.4 cm. Additionally at 1\no'clock in the retroareolar area there is a 0.4 x 0.3 x 0.4 cm hypoechoic mass\nwhich may represent a complicated cyst. This is in continuity with the focal\narea of dilated ducts.", + "output": "1. Dilated ducts with suspicious calcifications at the 2 o'clock position. \nUltrasound-guided biopsy of this area, possibly with vacuum assistance, is\nrecommended. Given that the focal architectural distortion appears to be in\nthis same area, management of that finding will be based on the biopsy\nresults.\n2. No mammographic or ultrasound findings to account for focal pain left\nbreast.\n3. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of dilated ducts with associated\ncalcifications is recommended. Additionally an addendum will be issued once\nprior imaging is available for comparison.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient via an interpreter who agrees with this plan. She was given\ninformation to schedule her biopsy. An e-mail was also sent to the ordering\nprovider ___ at 17:00 ___.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Pre biopsy imaging again demonstrates dilated ducts containing debris and\ncalcifications at the 2 o'clock position left breast 2 cm from the nipple. \nThese were targeted for vacuum assisted ultrasound-guided biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___, M.D.. The procedure was supervised by ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 11-gauge coaxial needle and 12-gauge ATEC vacuum-assisted biopsy\ndevicewere used to obtain 7 cores. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: A mammogram of the specimen was obtained confirming the presence of\ncalcifications. Specimen was separated into 2 separate containers, 1\ncontaining calcifications and 1 not containing calcifications, and sent to\npathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Pre biopsy imaging again demonstrates dilated ducts containing debris and\ncalcifications at the 2 o'clock position left breast 2 cm from the nipple. \nThese were targeted for vacuum assisted ultrasound-guided biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___, M.D.. The procedure was supervised by ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 11-gauge coaxial needle and 12-gauge ATEC vacuum-assisted biopsy\ndevicewere used to obtain 7 cores. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: A mammogram of the specimen was obtained confirming the presence of\ncalcifications. Specimen was separated into 2 separate containers, 1\ncontaining calcifications and 1 not containing calcifications, and sent to\npathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Pre biopsy imaging again demonstrates dilated ducts containing debris and\ncalcifications at the 2 o'clock position left breast 2 cm from the nipple. \nThese were targeted for vacuum assisted ultrasound-guided biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___, M.D.. The procedure was supervised by ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 11-gauge coaxial needle and 12-gauge ATEC vacuum-assisted biopsy\ndevicewere used to obtain 7 cores. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: A mammogram of the specimen was obtained confirming the presence of\ncalcifications. Specimen was separated into 2 separate containers, 1\ncontaining calcifications and 1 not containing calcifications, and sent to\npathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Targeted ultrasound of the left medial knee demonstrates an approximately 5.8\nx 4.9 x 8.0 cm collection with thick septations along the periphery. The\ncollection contains a 4.6 x 3.1 x 7.2 cm anechoic fluid component which was\ntargeted for aspiration.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Total of 160 cc of serosanguineous fluid was removed from the\ncollection." + }, + { + "input": "There is an avascular septated fluid collection within the left medial thigh.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 111 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 44, 46, and 53 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 18\ncm/sec.\nThe ICA/CCA ratio is 0.47.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 64, 66, and 89 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 36\ncm/sec.\nThe ICA/CCA ratio is 0.86.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA<40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere are stable post treatment changes in the right breast. There is a 0.4\ncm circumscribed mass in the central outer breast at middle depth which was\nfurther evaluated by ultrasound. Additionally BB marker is placed in the far\nmedial breast in the area of concern as indicated by the patient. There is\nsuggestion of a fat containing lucent mass. This was further evaluated with\nultrasound. There is no unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nBREAST ULTRASOUND: Physical exam of the area of concern as indicated by the\npatient reveals a soft mobile mass. Targeted ultrasound was performed in the\narea of concern as indicated by the patient. There is a 2.3 x 3.6 x 1.2 cm\nslightly heterogeneous oval circumscribed mass with areas of increased\nechogenicity most consistent with a lipoma.\n\nTargeted ultrasound was performed in the area of concern on mammography. At 3\no'clock 4 cm from the nipple there is a 0.2 x 0.3 cm probable cyst. However\ngiven that this is very small in size, confirmation is difficult with\nultrasound. Six-month follow-up seems reasonable at this time.", + "output": "1. Benign lipoma corresponding to the area of concern in the left breast.\n2. Probably benign mass in the left breast for which six-month follow-up\nmammogram and ultrasound is recommended.\n\nRECOMMENDATION(S): Left diagnostic mammogram and ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere are stable post treatment changes in the right breast. There is a 0.4\ncm circumscribed mass in the central outer breast at middle depth which was\nfurther evaluated by ultrasound. Additionally BB marker is placed in the far\nmedial breast in the area of concern as indicated by the patient. There is\nsuggestion of a fat containing lucent mass. This was further evaluated with\nultrasound. There is no unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nBREAST ULTRASOUND: Physical exam of the area of concern as indicated by the\npatient reveals a soft mobile mass. Targeted ultrasound was performed in the\narea of concern as indicated by the patient. There is a 2.3 x 3.6 x 1.2 cm\nslightly heterogeneous oval circumscribed mass with areas of increased\nechogenicity most consistent with a lipoma.\n\nTargeted ultrasound was performed in the area of concern on mammography. At 3\no'clock 4 cm from the nipple there is a 0.2 x 0.3 cm probable cyst. However\ngiven that this is very small in size, confirmation is difficult with\nultrasound. Six-month follow-up seems reasonable at this time.", + "output": "1. Benign lipoma corresponding to the area of concern in the left breast.\n2. Probably benign mass in the left breast for which six-month follow-up\nmammogram and ultrasound is recommended.\n\nRECOMMENDATION(S): Left diagnostic mammogram and ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nAgain seen in the central outer left breast, at middle depth, is an\napproximately 5 mm, oval, well-circumscribed, equal density mass, unchanged\ncompared to prior mammogram. No unexplained architectural distortion or\nsuspicious grouped microcalcifications are seen.\n\nBREAST ULTRASOUND: In the area of previous ultrasound finding, at 3 o'clock,\n4 cm from nipple, a 0.2 x 0.1 x 0.2 cm hypoechoic circumscribed oval parallel\nmass, which has decreased compared to prior and is benign. This area is not\nthought to be the area of abnormality on mammography. However, at 1 o'clock,\n5 cm from the nipple, there is a 0.4 x 0.2 x 0.6 cm hypoechoic circumscribed\noval parallel mass, which appears consistent with a cluster of cysts and\ncorresponds to the circumscribed mass on mammography. Overall, these findings\nare likely benign and will be best assessed on mammography in the future. \nFollow-up diagnostic mammography in 6 months alongside annual imaging of the\nright breast is recommended.", + "output": "1. Unchanged 5 mm circumscribed probably benign mass in the upper outer left\nbreast, at middle depth. Correlate ultrasound findings suggest a cluster of\ncysts. These findings are best followed on mammography in the future.\nRecommend follow-up diagnostic mammography in 6 months, alongside patient's\nannual right-sided mammography.\n2. Previously seen, likely tiny cyst, has decreased in size compared to prior,\nbenign.\n\nRECOMMENDATION(S): Recommend follow-up diagnostic mammography of the left\nbreast in 6 months alongside annual right breast mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nNo suspicious grouped calcifications, unexplained architectural distortion or\ndominant masses are present in either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right inferior outer breast in\nthe area of visible scar demonstrates post biopsy scarring without suspicious\nabnormality. Targeted ultrasound in the region of pain in the right breast at\nthe 8 o'clock position demonstrates no abnormality.", + "output": "No mammographic there sonographic abnormality in either breast.\n\nRECOMMENDATION: 1. Annual screening mammography.\n2. Continued clinical followup for area of pain in the right breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Upon obtaining further history from patient, she reports a 2 week history of\ndiffuse right breast swelling and discomfort. She also states that her right\narm is swollen and that there is a palpable lump along the right lateral chest\nextending to the flank. She also reports bilateral leg swelling, slightly\ngreater on the right compared to the left.\n\nUltrasound evaluation of the entire right breast was performed. The right\nbreast is markedly enlarged and swollen compared to the left. There is\ndiffuse right breast skin thickening measuring 7-8 mm. There is marked\ndiffuse edema of the tissues, with fluid seen along the tissue planes. No\ndiscrete mass is noted.\n\nUltrasound evaluation of both axilla was also performed. Sonographically\nnormal lymph nodes are seen. No enlarged lymph nodes or other worrisome\ncystic or solid masses identified. There is edema of the axillary tissues on\nthe right, similar to the right. No edema is seen involving the axillary\ntissue on the left.\n\nThe patient also reports a soft mobile lump along the right lateral chest\nextending to the flank. This is separate from the breast. Ultrasound of this\narea also demonstrates skin thickening, edema, and fluid between the tissue\nplanes.", + "output": "No sonographic evidence for malignancy. Marked edema and skin thickening\ninvolving the right breast and right axilla, extending in to the right lateral\nchest and flank.\n\nRECOMMENDATION(S): Final disposition of any clinical findings should be based\non clinical grounds. Given clinical findings an sonographic appearances,\netiology does not appear to be of breast origin. Etiology may be related to\ncardiac and/or central vascular issues.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Findings were also discussed with Dr. ___ by telephone at 11:00 on\nthe day of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is bilateral diffuse skin thickening and increased trabecular thickening\nof both breasts, right greater than left. This is a marked changed from the\nmost recent prior mammogram from ___. Given the bilateral nature\nof these findings and the extensive cardiac and pulmonary history, this is\nmost consistent with bilateral cardiogenic edema. There is no suspicious\nmass, suspicious grouped microcalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the bilateral axilla\ndue to the clinical exam findings. At least 3 prominent lymph nodes are seen\non the right. The most medially located lymph node is enlarged measuring 1.6\nx 0.5 x 1.6 cm with a cortical thickness of 5 mm. A second enlarged lymph\nnode labeled mid axilla is also enlarged with a cortical thickness of 4 mm. \nThe most lateral lymph node measures approximately 1.7 x 0.6 x 1.5 cm with a\ncortical thickness of 5 mm. These are new when compared to chest CT from ___. A normal lymph node is identified in the left axilla without any\nsonographic evidence of lymphadenopathy.", + "output": "1. Bilateral diffuse extensive skin thickening and increased trabecular\nthickening involving the breasts most compatible with a systemic process\nlikely related to the patient's cardiac and pulmonary dysfunction. Clinical\nfollow-up is recommended.\n2. 3 enlarged right axillary lymph nodes. The etiology of this\nlymphadenopathy is unclear although possibly could be reactive. The options\nof tissue sampling versus short interval follow-up were discussed with the\npatient. She is currently on Eliquis and is going to be evaluated in the\nemergency department for increasing lower extremity edema medially after this\nexam. Given the acute comorbidities and the fact that she is on a blood\nthinning medication, short interval follow-up seems a reasonable approach at\nthis time. Alternatively, if definitive diagnosis is required sooner, a FNA\ncan be performed while she is on Eliquis.\n\nRECOMMENDATION(S): Right axillary ultrasound in 1 month.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient. \nFindings were also emailed to Dr. ___ by Dr. ___ on ___\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is bilateral diffuse skin thickening and increased trabecular thickening\nof both breasts, right greater than left. This is a marked changed from the\nmost recent prior mammogram from ___. Given the bilateral nature\nof these findings and the extensive cardiac and pulmonary history, this is\nmost consistent with bilateral cardiogenic edema. There is no suspicious\nmass, suspicious grouped microcalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the bilateral axilla\ndue to the clinical exam findings. At least 3 prominent lymph nodes are seen\non the right. The most medially located lymph node is enlarged measuring 1.6\nx 0.5 x 1.6 cm with a cortical thickness of 5 mm. A second enlarged lymph\nnode labeled mid axilla is also enlarged with a cortical thickness of 4 mm. \nThe most lateral lymph node measures approximately 1.7 x 0.6 x 1.5 cm with a\ncortical thickness of 5 mm. These are new when compared to chest CT from ___. A normal lymph node is identified in the left axilla without any\nsonographic evidence of lymphadenopathy.", + "output": "1. Bilateral diffuse extensive skin thickening and increased trabecular\nthickening involving the breasts most compatible with a systemic process\nlikely related to the patient's cardiac and pulmonary dysfunction. Clinical\nfollow-up is recommended.\n2. 3 enlarged right axillary lymph nodes. The etiology of this\nlymphadenopathy is unclear although possibly could be reactive. The options\nof tissue sampling versus short interval follow-up were discussed with the\npatient. She is currently on Eliquis and is going to be evaluated in the\nemergency department for increasing lower extremity edema medially after this\nexam. Given the acute comorbidities and the fact that she is on a blood\nthinning medication, short interval follow-up seems a reasonable approach at\nthis time. Alternatively, if definitive diagnosis is required sooner, a FNA\ncan be performed while she is on Eliquis.\n\nRECOMMENDATION(S): Right axillary ultrasound in 1 month.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient. \nFindings were also emailed to Dr. ___ by Dr. ___ on ___\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. A vague somewhat compressible asymmetry is seen in the\nupper central left breast. There are no associated microcalcifications. This\nwas further evaluated with ultrasound.\n\nUltrasound of the left breast from ___ o'clock 1-10 cm from the nipple in\nthe area of concern on mammography was performed. A 0.6 x 0.4 x 0.5 cm\nirregular hypoechoic mass with an echogenic halo is seen at 11 o'clock 8 cm\nfrom the nipple. In addition, a 0.4 x 0.3 x 0.3 cm more circumscribed mass is\nseen at 12 o'clock 5 cm from the nipple. Biopsy of both of these findings is\nrecommended at this time. These should be amenable to ultrasound-guided core\nbiopsy.", + "output": "Two solid masses in the left breast at ___ o'clock for which\nultrasound-guided core biopsy is advised at this time. The lesion at 11\no'clock is felt to more likely correspond to the asymmetry seen on recent\nmammography.\n\nRECOMMENDATION: Left breast ultrasound-guided core biopsy\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. The\npatient scheduled the followup appointment upon leaving the department. \nResults were also communicated by phone to Dr. ___ at 16:27 30\nminutes after completion of the diagnostic evaluation.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "There is a 3 x 3 x 3 mm hypoechoic, avascular, round mass at the 12 o'clock\nposition, 5 cm from the nipple, in the left breast. There is a 5 x 5 x 5 mm\nhypoechoic, avascular mass with an echogenic halo at the 11 o'clock position,\n8 cm from the nipple, in the left breast.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. and ___, MD. ___ procedure was\nsupervised by ___, M.D. (Attending).\n\nDescription of the core needle biopsy of the 11 o'clock lesion: Using\nultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the lesion in the 11 o'clock position\nand 6 cores were obtained using a 14-gauge Bard spring-loaded biopsy device. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nDescription of cyst aspiration at the 12 o'clock position: Using ultrasound\nguidance, aseptic technique and 1% lidocaine for local anesthesia, an 18 gauge\nneedle was placed into the lesion and trace yellowish clear fluid was\naspirated. The fluid was discarded due to lack of suspicion. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Specimens from the 11 o'clock mass were sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast 11 o'clock\nlesion with aspiration of the 12 o'clock cyst. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "There is a 3 x 3 x 3 mm hypoechoic, avascular, round mass at the 12 o'clock\nposition, 5 cm from the nipple, in the left breast. There is a 5 x 5 x 5 mm\nhypoechoic, avascular mass with an echogenic halo at the 11 o'clock position,\n8 cm from the nipple, in the left breast.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. and ___, MD. ___ procedure was\nsupervised by ___, M.D. (Attending).\n\nDescription of the core needle biopsy of the 11 o'clock lesion: Using\nultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the lesion in the 11 o'clock position\nand 6 cores were obtained using a 14-gauge Bard spring-loaded biopsy device. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nDescription of cyst aspiration at the 12 o'clock position: Using ultrasound\nguidance, aseptic technique and 1% lidocaine for local anesthesia, an 18 gauge\nneedle was placed into the lesion and trace yellowish clear fluid was\naspirated. The fluid was discarded due to lack of suspicion. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Specimens from the 11 o'clock mass were sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast 11 o'clock\nlesion with aspiration of the 12 o'clock cyst. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 200 cc of red, serosanguinous fluid\nSamples: Fluid samples were submitted to the laboratory for the requested\nanalysis.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 200 cc of fluid were removed and sent for analysis." + }, + { + "input": "There is an anechoic ___ cyst within the left popliteal fossa measuring 4.8\nx 1.9 x 4.4 cm.", + "output": "Left ___ cyst measuring 4.8 x 1.9 x 4.4 cm." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.2 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential,\nculture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.7 L of green-yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.5 L of straw-colored ascitic fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis, yielding\n3.5 L of straw-colored ascitic fluid." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 79 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 73, 76, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 0.96.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 66, 68, and 63 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.99.\nThe external carotid artery has peak systolic velocity of 50 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of hemodynamically significant stenosis in the bilateral ICAs." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nTARGETED LEFT BREAST ULTRASOUND:\nLeft ultrasound was performed over the area of focal pain as indicated by the\npatient. The area from ___ o'clock was scanned and no discrete solid or\ncystic mass was seen.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Final disposition of pain should be based on clinical\nevaluation. Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nTARGETED LEFT BREAST ULTRASOUND:\nLeft ultrasound was performed over the area of focal pain as indicated by the\npatient. The area from ___ o'clock was scanned and no discrete solid or\ncystic mass was seen.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Final disposition of pain should be based on clinical\nevaluation. Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\n2 BB markers in the left upper outer breast are bracketing the area of\npalpable abnormality as indicated by the patient. A focal nodular asymmetry\nis noted in the inner central left breast measuring approximately 8 mm. There\nis no architectural distortion or suspicious grouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of the\npalpable abnormality, which is linear and superficial running in the\ncranial-caudal plane with a visible cord on exam. In the superficial tissues,\nthere is a focally dilated vessel without demonstrable flow coursing from the\nnipple to 12:30 o'clock 6 cm from the nipple compatible with a thrombosed\nsuperficial vein.", + "output": "1. 0.8 cm left nodular asymmetry was not evaluated by ultrasound at the time\nof evaluation of the patient's palpable abnormality.\n2. ___ disease of the left breast corresponding to the palpable\nabnormality.\n\nRECOMMENDATION(S): 1. Recommend returning to the breast imaging department at\nno cost to the patient for left breast ultrasound to further evaluate the\nnodular asymmetry seen on her mammogram.\n2. Clinical followup is recommended for the patient's left ___ disease.\n\nNOTIFICATION: Finding #2 was reviewed with the patient at the completion of\nthe study. All the above findings and recommendations were emailed by Dr. ___\n___ to the ordering provider, Dr. ___, at 4:15PM on ___.\n\nBI-RADS: 0 Incomplete - Need Additional Imaging \nEvaluation." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\n2 BB markers in the left upper outer breast are bracketing the area of\npalpable abnormality as indicated by the patient. A focal nodular asymmetry\nis noted in the inner central left breast measuring approximately 8 mm. There\nis no architectural distortion or suspicious grouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of the\npalpable abnormality, which is linear and superficial running in the\ncranial-caudal plane with a visible cord on exam. In the superficial tissues,\nthere is a focally dilated vessel without demonstrable flow coursing from the\nnipple to 12:30 o'clock 6 cm from the nipple compatible with a thrombosed\nsuperficial vein.", + "output": "1. 0.8 cm left nodular asymmetry was not evaluated by ultrasound at the time\nof evaluation of the patient's palpable abnormality.\n2. ___ disease of the left breast corresponding to the palpable\nabnormality.\n\nRECOMMENDATION(S): 1. Recommend returning to the breast imaging department at\nno cost to the patient for left breast ultrasound to further evaluate the\nnodular asymmetry seen on her mammogram.\n2. Clinical followup is recommended for the patient's left ___ disease.\n\nNOTIFICATION: Finding #2 was reviewed with the patient at the completion of\nthe study. All the above findings and recommendations were emailed by Dr. ___\n___ to the ordering provider, Dr. ___, at 4:15PM on ___.\n\nBI-RADS: 0 Incomplete - Need Additional Imaging \nEvaluation." + }, + { + "input": "At 9 o'clock 5 cm from the nipple, there is a 0.7 x 0.6 x 0.3 cm ovoid\nwell-circumscribed isoechoic mass with internal foci of hypo- or\nan-echogenicity compatible with a cluster of cysts, which is felt to\ncorrespond to the 0.7 cm nodular asymmetry on the preceding mammogram. No\nworrisome solid or cystic masses are identified.\n\nAgain seen is a focally dilated and noncompressible vessel at 12:30 5 cm from\nthe nipple corresponding to the patient's known thrombosed superficial vein\n___ disease).", + "output": "1. No sonographic evidence of malignancy.\n2. Cluster of cysts corresponding to the mammographic abnormality.\n3. Persistent ___ disease of the left breast.\n\nRECOMMENDATION(S): Clinical followup is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA 6 mm round, circumscribed asymmetry is present in the upper likely outer\nleft breast at posterior depth, only seen on the MLO view. This is possibly\nan intramammary lymph node. There are grouped amorphous calcifications in the\nupper left breast spanning 7 x 3 mm at posterior depth, only seen on the MLO\nmagnification view. There is no unexplained architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast from ___ o'clock,\n1-16 cm from the nipple, corresponding to the area of the mammographic\nasymmetry, demonstrates no focal solid mass or cystic lesion. Incidental note\nis made of an 11 mm lymph node with preserved echogenic fatty hilum and normal\ncortical thickness at 2 o'clock 16 cm from the nipple. Evaluation of the left\naxilla demonstrates no lymphadenopathy.", + "output": "1. Left breast calcifications are indeterminate, and only seen on the MLO\nprojection. A stereotactic biopsy is recommended for definitive diagnosis.\n2. Left breast 6 mm mammographic asymmetry without sonographic correlate. \nAlthough this finding likely represents a benign process such as an\nintramammary lymph node, follow-up in 6 months is recommended.\n\nRECOMMENDATION(S): Findings were discussed with the patient and the patient's\nmother (legal guardian). Given that the patient may not be able to tolerate\npositioning for a stereotactic core needle biopsy, options of short-term\nthree-month imaging follow-up versus stereotactic core needle biopsy were\ndiscussed with the patient and her mother. The patient's mother would like to\nthink about whether or not this would be feasible for the patient, and she\nwill call to schedule a biopsy or three-month imaging follow-up.\n\nIf a stereotactic core needle biopsy is not performed, consideration should be\ngiven to tomosynthesis to better localize the left breast calcifications on\nthe MLO view, as these were not able to be localized in two views on today's\nstudy, at the time of the patient's followup.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient and\nher mother (legal guardian) who agrees with the plan. She was given\ninformation to schedule her follow-up or stereotactic core needle biopsy.\n\nThese findings were communicated directly to Dr. ___ via email at 17:18\non ___ by Dr. ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA 6 mm round, circumscribed asymmetry is present in the upper likely outer\nleft breast at posterior depth, only seen on the MLO view. This is possibly\nan intramammary lymph node. There are grouped amorphous calcifications in the\nupper left breast spanning 7 x 3 mm at posterior depth, only seen on the MLO\nmagnification view. There is no unexplained architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast from ___ o'clock,\n1-16 cm from the nipple, corresponding to the area of the mammographic\nasymmetry, demonstrates no focal solid mass or cystic lesion. Incidental note\nis made of an 11 mm lymph node with preserved echogenic fatty hilum and normal\ncortical thickness at 2 o'clock 16 cm from the nipple. Evaluation of the left\naxilla demonstrates no lymphadenopathy.", + "output": "1. Left breast calcifications are indeterminate, and only seen on the MLO\nprojection. A stereotactic biopsy is recommended for definitive diagnosis.\n2. Left breast 6 mm mammographic asymmetry without sonographic correlate. \nAlthough this finding likely represents a benign process such as an\nintramammary lymph node, follow-up in 6 months is recommended.\n\nRECOMMENDATION(S): Findings were discussed with the patient and the patient's\nmother (legal guardian). Given that the patient may not be able to tolerate\npositioning for a stereotactic core needle biopsy, options of short-term\nthree-month imaging follow-up versus stereotactic core needle biopsy were\ndiscussed with the patient and her mother. The patient's mother would like to\nthink about whether or not this would be feasible for the patient, and she\nwill call to schedule a biopsy or three-month imaging follow-up.\n\nIf a stereotactic core needle biopsy is not performed, consideration should be\ngiven to tomosynthesis to better localize the left breast calcifications on\nthe MLO view, as these were not able to be localized in two views on today's\nstudy, at the time of the patient's followup.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient and\nher mother (legal guardian) who agrees with the plan. She was given\ninformation to schedule her follow-up or stereotactic core needle biopsy.\n\nThese findings were communicated directly to Dr. ___ via email at 17:18\non ___ by Dr. ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 46 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 43, 53, and 52 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 45 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 46 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 34, 50, and 52 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 42 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of atherosclerotic disease in the bilateral carotid vasculature." + }, + { + "input": "Multiple hypoechoic liver lesions were seen and the lesion in right hepatic\nlobe close to the skin was selected for biopsy.", + "output": "Successful ultrasound-guided targeted biopsy of the right hepatic lobe lesion." + }, + { + "input": "Ultrasound of the right breast at ___ o'clock 5 cm from the nipple identifies\na 2.7 cm heterogeneous subcutaneous lesion with a contiguous 1.1 cm\nsubcutaneous collection at ___ o'clock 5 cm from the nipple. There is\nassociated diffuse skin thickening in this region. Findings would be most\nconsistent with an infected draining sebaceous or epidermoid inclusion cyst. \nClinical management is indicated at this time. The patient was further\nevaluated in the Breast Care Center following completion of the diagnostic\nultrasound. Once the patient's clinical symptoms resolve, followup\nmammography in six months to ensure resolution of the skin thickening should\nbe considered.", + "output": "Draining subcutaneous mass and collection with associated skin thickening at\n___ o'clock corresponding the area of concern as indicated by the patient and\non mammography favoring a benign process such as a ruptured sebaceous or\nepidermoid inclusion cyst. Clinical management is recommended at this time.\n\nFollowup diagnostic mammography of the right breast in six months should be\nconsidered once the patient's clinical symptoms resolved.\n\nRECOMMENDATION: Clinical followup. The patient was evaluated in the Breast\nCare Center following completion of the diagnostic ultrasound. Right\ndiagnostic mammography in six months.\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\n\nThere is a 13 x 6 x 7 mm ill-defined focal asymmetry in the posterior right\nupper central breast. This is new from ___. This area was further assessed\nwith ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper central right breast was\nperformed with attention to the mammographic abnormality. Upon obtaining\nfurther history from the patient she reports a fall earlier this year. At 1\no'clock, 9 cm from the nipple, in the superficial breast, there is a mixed\nechogenicity lesion with ill-defined borders, measuring 15 x 14 x 9 mm. This\nis primarily echogenic with central decreased echogenicity. There is no\ninternal vascularity or posterior shadowing. Appearances are suggestive of\nresolving hematoma/fat necrosis.", + "output": "Probably benign focal asymmetry on mammography, with ultrasound findings\nsuggestive of a resolving hematoma/fat necrosis. Patient does report a\nhistory of trauma earlier this year.\n\nRECOMMENDATION(S): 3 month follow up targeted ultrasound is recommended for\ncontinued close imaging surveillance. If tissue diagnosis is desired, this is\namenable to ultrasound-guided core biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with plan for ultrasound follow-up in 3 months. An\nappointment slip was given to her prior to leaving the department.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\n\nThere is a 13 x 6 x 7 mm ill-defined focal asymmetry in the posterior right\nupper central breast. This is new from ___. This area was further assessed\nwith ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper central right breast was\nperformed with attention to the mammographic abnormality. Upon obtaining\nfurther history from the patient she reports a fall earlier this year. At 1\no'clock, 9 cm from the nipple, in the superficial breast, there is a mixed\nechogenicity lesion with ill-defined borders, measuring 15 x 14 x 9 mm. This\nis primarily echogenic with central decreased echogenicity. There is no\ninternal vascularity or posterior shadowing. Appearances are suggestive of\nresolving hematoma/fat necrosis.", + "output": "Probably benign focal asymmetry on mammography, with ultrasound findings\nsuggestive of a resolving hematoma/fat necrosis. Patient does report a\nhistory of trauma earlier this year.\n\nRECOMMENDATION(S): 3 month follow up targeted ultrasound is recommended for\ncontinued close imaging surveillance. If tissue diagnosis is desired, this is\namenable to ultrasound-guided core biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with plan for ultrasound follow-up in 3 months. An\nappointment slip was given to her prior to leaving the department.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Thyroid ultrasound 1 o'clock right breast 9 cm from the nipple demonstrates\nsignificant interval decrease in size previously described avascular mixed\nechogenicity lesion which currently measures 0.9 x 0.2 x 0.2 cm and previously\nmeasured 0.9 x 0.4 cm consistent a resolving hematoma/area of fat necrosis.", + "output": "Ultrasound findings consistent with resolving hematoma/fat necrosis is benign.\n\nRECOMMENDATION(S): Agent risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Mammogram:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is an approximately 16 mm oval partially circumscribed equal density\nmass in the upper-outer left breast at posterior depth. There are no\nassociated calcifications or areas of architectural distortion. The second\npartially obscured mass identified on the recent screening mammogram in the\nupper-outer left breast is not well seen on today's examination and is better\nappreciated on the tomosynthesis views dated ___.\nThere are no additional new suspicious findings in the left breast.\nBenign-appearing round calcifications are again noted.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper-outer left breast was\nperformed. There are many simple cysts throughout the upper-outer left breast\nwith the largest measuring approximately 1.5 cm in the 3 o'clock position 6 cm\nfrom the nipple, correlating to the dominant mass in the left breast seen on\nthe mammogram. There are multiple additional cysts, correlating to the\npartially obscured masses on the mammogram. There are no suspicious solid or\ncystic masses.", + "output": "Partially obscured masses in the upper-outer left breast on the recent\nscreening mammogram correspond to simple cysts. This is a benign finding.\n\nRECOMMENDATION: Annual screening mammography is recommended for which patient\nwill be due in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "AT 9 O'CLOCK, ___ CM FROM THE NIPPLE, THERE IS A SMALL HYPOECHOIC NODULE\nMEASURING 3 4 MM IN DIAMETER.\n\nAT 4 O'CLOCK, 2 CM FROM THE NIPPLE, THERE ARE A FEW SMALL HYPOECHOIC NODULES\nIN A GROUP. SOME OF THEM APPEAR CALCIFIED. THE GROUP MEASURES 1 CM IN THE\nLARGEST DIAMETER. THIS IS STABLE SINCE ___", + "output": "STABLE RIGHT BREAST NODULES AT 4 O'CLOCK AND 9 O'CLOCK.\n\nRECOMMENDATION: FOLLOWUP RIGHT BREAST ULTRASOUND IN ___ YEAR\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the right breast in the areas clinical concern at 4\no'clock position 9 o'clock position was performed. In the 4 o'clock position\n2 cm from the nipple there is a conglomerate of small hypoechoic masses\nmeasuring approximately 10 x 4 x 5 mm. There is no internal vascularity. No\nposterior acoustic features are seen. Careful ultrasound of the outer right\nbreast was performed. In the area of previously seen 4 mm well-circumscribed\nmass in the 9 o'clock position 7 cm from the nipple no suspicious cystic or\nsolid masses are seen. There are no new suspicious solid or cystic masses.", + "output": "18 month stability of probably benign masses in the 4 o'clock position in the\nright breast. Previously seen 4 mm mass in the 9 o'clock position is no\nlonger visualized.\n\nRECOMMENDATION(S): ___ year followup ultrasound the right breast is\nrecommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is an oval circumscribed mass in the upper-outer quadrant of left breast\ncorresponding to the area palpable concern as indicated by the patient\nmeasuring 11 mm in greatest dimension. There is a and oval previously\nbiopsied mass in the lower-inner quadrant of the left breast containing a\nRadian clip measuring up to 26 mm. There are no spiculated masses,\narchitectural distortion, or suspicious groups of microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound left breast in the area palpable\nconcern as indicated by the patient at 1 o'clock, 6 cm from the nipple\ndemonstrates an oval hypoechoic mass measuring 8 mm by 5 mm x 7 mm, likely\nrepresent a fibroadenoma. Follow-up is recommended.", + "output": "Probable fibroadenoma corresponding to the area of palpable concern as\nindicated by the patient. Follow-up is recommended.\n\nRECOMMENDATION(S): Left breast ultrasound in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted sonography of the left breast at 1 o'clock 6 cm from nipple\ndemonstrates a hypoechoic ovoid parallel mass measuring 0.9 by 0.7 x 0.4 cm. \nThis is not changed since the study of ___ and was previously seen\non ___ and ___. It is smaller in size compared to\nthose studies.", + "output": "Left breast mass at 1 o'clock 6 cm from nipple is a stable a known finding. \nNo further follow-up is indicated.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is a 1.2 x 0.9 x 0.6 cm simple cyst at the 4 o'clock position\nretroareolar right breast corresponding to mammographic Findings.", + "output": "1.2 cm simple cyst 4:00 position retroareolar right breast corresponding to\nmass seen on mammogram.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 72 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 79, 81, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 88 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 61, 76, and 87 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 87 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the bilateral internal carotid arteries with mild\nheterogeneous plaque bilaterally." + }, + { + "input": "There is moderate to severe right common femoral artery plaque.\n\nPeak systolic velocities are as follows:\nCommon femoral artery : Peak systolic velocity is 240 cm/sec.\nProximal superficial femoral artery: Peak systolic velocity is 171 cm/sec\nMid superficial femoral artery : Peak systolic velocity is 93 cm/sec\nDistal superficial femoral artery ; Peak systolic velocity is 69 cm/sec\nPopliteal artery : Peak systolic velocity is 57 cm/sec\nPosterior tibial artery: Peak systolic velocity is 88 cm/sec\nPeroneal artery : Peak systolic velocity is 33 cm/sec", + "output": "Mild atherosclerotic plaque in the proximal right superficial femoral artery. \nNo evidence of occlusion." + }, + { + "input": "Ultrasound of the right radial artery demonstrates a pulsatile single-lumen\nnon-compressible vessel. There is evidence of needle access into the arterial\nlumen.\n\nRight radial artery: There is good distal runoff. There is no evidence of\ndissection. Vascular caliber is appropriate for catheterization. No\nsignificant stenosis or tortuosity.\n\nRight vertebral artery: The right vertebral artery is smooth and regular and\nfills the vertebrobasilar system. There is filling of the bilateral anterior\ninferior cerebral artery with bilateral ___ complexes. There is filling\nof the bilateral superior cerebellar artery and bilateral posterior cerebral\nartery and its distal territories. Normal capillary and venous phases.\n\nRight internal carotid artery: The right internal carotid artery is smooth and\nregular. There is filling of the ophthalmic artery with a retinal blush. \nThere is filling of the right M1 segment and the middle cerebral artery and\nits distal territories. There is right MCA bifurcation aneurysm measuring 4.4\nx 3.2 mm. There is filling of the right A1 segment and the bilateral anterior\ncerebral artery and its distal territories. Normal capillary and venous\nphases.\n\nLeft common carotid artery: The left internal carotid artery is smooth and\nregular. There is filling of the left M1 segment and the middle cerebral\nartery and its distal territories. There is filling of the left A1 segment\nand the bilateral anterior cerebral artery is territories. The ophthalmic\nartery is visualized. The branches of the external carotid artery are\nadequately visualized and appears smooth and regular. No additional aneurysms\nor high flow vascular lesion is identified.", + "output": "1. Right MCA bifurcation aneurysm measuring 4.4 x 3.2 mm.\n\nI,Dr. ___, was personally present and participated in the entirety of the\nprocedure; I have reviewed the above images and agree with the findings as\nstated above.\n\nRECOMMENDATION(S):\n1. Treatment options will be discussed during our weekly cerebrovascular\nconference." + }, + { + "input": "In the 3 o'clock, 12 o'clock, 9 o'clock, 6 o'clock and retroareolar positions\nof the left breast, there is no suspicious solid or cystic mass.", + "output": "No sonographic abnormality in the area of clinical concern left breast. Any\ndecision for further intervention should be noted that the clinical\nassessment.\n\nRECOMMENDATION(S): Clinical follow-up. Patient is aware of prior\nrecommendation from mammogram for six-month interval follow-up of\ncalcifications.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Heterogeneous echogenic material within the endometrial cavity measuring 2.7\ncm in thickness was present prior to the operation. Subsequently evacuation of\nthe endometrial component showed an empty endometrial canal. The outer\nuterine contour and myometrium appeared intact after the procedure.", + "output": "Sonographic guidance provided in OR. Please refer to operative note for\ndetails of the procedure." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n15 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild, heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 102 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 93, 82, and 72 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.9..\nThe external carotid artery has peak systolic velocity of 119 cm/sec.\nThe vertebral artery is patent with antegrade, high resistance waveform. The\nend-diastolic velocity in the vertebral artery is 0 cm/ second and may\nindicate more distal vertebral occlusive disease.\n\nLEFT:\nThe left carotid vasculature has mild, heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 71 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 73, 98, and 89 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 124 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral mild, heterogeneous plaque with bilateral ___ ICA stenosis.\nRight vertebral artery resistive waveform consistent with distal right\nvertebral occlusive disease." + }, + { + "input": "Transverse and sagittal images were obtained of the superficial tissues of the\ndorsal penis. In the superficial subcutaneous tissue of the mid shaft of the\ndorsal penis, just to the right of midline overlying the corpus cavernosum is\na 3.0 x 1.9 x 3.2 cm heterogeneous complex collection with through\ntransmission and no internal vascularity.", + "output": "Superficial 3.2 cm complex heterogeneous collection compatible with abscess in\nthe mid shaft of the penis just the right of midline overlying the corpus\ncavernosum." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications. The asymmetry seen on recent screening\nmammogram appears to represent normal breast tissue on spot compression 3D\nviews.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed throughout the\nupper-outer left breast which was without any discrete suspicious solid or\ncystic masses.", + "output": "No suspicious sonographic or mammographic findings are confirmed in the area\nof concern seen in the upper outer left breast on recent screening mammogram.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications. The asymmetry seen on recent screening\nmammogram appears to represent normal breast tissue on spot compression 3D\nviews.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed throughout the\nupper-outer left breast which was without any discrete suspicious solid or\ncystic masses.", + "output": "No suspicious sonographic or mammographic findings are confirmed in the area\nof concern seen in the upper outer left breast on recent screening mammogram.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: Spot compression views demonstrated well-circumscribed ovoid\nheterogeneous mass containing fat in the upper outer anterior right breast. \nRetrospectively this has been present previously and is not changed. The\ncharacteristics are consistent with a hamartoma.\n\n\nBREAST ULTRASOUND: Targeted sonography of the right breast at 10 o'clock 4 cm\nfrom nipple demonstrated a well-circumscribed heterogeneous mass containing\nfat measuring 2.6 x 0.9 x 1.7 cm. The sonographic characteristics are\nconsistent with a hamartoma.", + "output": "Right breast: Upper outer anterior right breast mass has characteristics of a\nbenign hamartoma and has been retrospectively present mammographically.\n\nRECOMMENDATION(S): Annual screening mammography\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 90 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 83, 81, and 50 seconds cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.92.\nThe external carotid artery has peak systolic velocity of 81 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 79 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 98, 62, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 90 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 85 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis.\n\nBilateral antegrade vertebral flow." + }, + { + "input": "In the right breast at 11 to 12 o'clock 7 cm from the nipple an irregular\nhypoechoic mass with angular margins and posterior shadowing measuring 0.7 x\n0.9 x 0.8 cm was identified as the targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___. and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast at 11 to 12 o'clock 7 cm from the nipple an irregular\nhypoechoic mass with angular margins and posterior shadowing measuring 0.7 x\n0.9 x 0.8 cm was identified as the targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___. and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Mammogram:\nTissue density: B - There are scattered areas of fibroglandular density.\nThere are no new suspicious abnormalities in either breast. Specifically, no\nareas of unexplained architectural distortion, suspicious grouped\ncalcifications or suspicious masses are seen in the vicinity of the radiopaque\nmarker placed in the area of palpable concern in the upper-outer left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the area of palpable concern in the\nupper-outer left breast was performed which was without any discrete\nsuspicious solid or cystic masses.", + "output": "There are no suspicious mammographic or sonographic findings in the area of\npalpable concern in left breast.\n\nRECOMMENDATION: Clinical followup of the area of palpable concern in left\nbreast. Any decision to biopsy and final patient disposition should be based\non clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Mammogram:\nTissue density: B - There are scattered areas of fibroglandular density.\nThere are no new suspicious abnormalities in either breast. Specifically, no\nareas of unexplained architectural distortion, suspicious grouped\ncalcifications or suspicious masses are seen in the vicinity of the radiopaque\nmarker placed in the area of palpable concern in the upper-outer left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the area of palpable concern in the\nupper-outer left breast was performed which was without any discrete\nsuspicious solid or cystic masses.", + "output": "There are no suspicious mammographic or sonographic findings in the area of\npalpable concern in left breast.\n\nRECOMMENDATION: Clinical followup of the area of palpable concern in left\nbreast. Any decision to biopsy and final patient disposition should be based\non clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is a 0.7 cm mass in the far posterior central right breast. On 3D\nimaging there is a fatty notch suggesting this represents a lymph node. \nHowever, given that it was more conspicuous than prior examinations,\nultrasound was performed.\n\nRight breast ultrasound: At 5 o'clock 7 8 cm from the nipple there is a 0.6 cm\nmass with an echogenic center and hypoechoic rind. This has a classic\nultrasound appearance for a lymph node. The cortex measures up to 0.1 cm\nconsistent with benign morphology. This corresponds well to the mammographic\nfinding.", + "output": "Right breast mass seen on screening mammography corresponds to a benign lymph\nnode.\n\nRECOMMENDATION(S): Return to screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is a 0.7 cm mass in the far posterior central right breast. On 3D\nimaging there is a fatty notch suggesting this represents a lymph node. \nHowever, given that it was more conspicuous than prior examinations,\nultrasound was performed.\n\nRight breast ultrasound: At 5 o'clock 7 8 cm from the nipple there is a 0.6 cm\nmass with an echogenic center and hypoechoic rind. This has a classic\nultrasound appearance for a lymph node. The cortex measures up to 0.1 cm\nconsistent with benign morphology. This corresponds well to the mammographic\nfinding.", + "output": "Right breast mass seen on screening mammography corresponds to a benign lymph\nnode.\n\nRECOMMENDATION(S): Return to screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "1. Heterogeneously hypoechoic mass within the right supraclavicular area\nmeasuring approximately 5.0 x 2.8 cm.\n2. Successful core needle biopsy of the right supraclavicular mass. Specimens\nwere sent to pathology for evaluation.", + "output": "Successful core needle biopsy of the right supraclavicular mass. Specimens\nwere sent to pathology for evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 92 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 85, 80, and 95 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 41 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 81 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has rather extensive calcified atherosclerotic\nplaque particularly in the proximal internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 104 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 80, 91, and 86 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 0.88.\nThe external carotid artery has peak systolic velocity of 159 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Mild heterogeneous atherosclerotic plaque in the right internal carotid\nartery resulting in less than 40% stenosis.\n\n2. Rather extensive calcified plaque involving the proximal left internal\ncarotid artery without evidence of a hemodynamically significant stenosis\n(Less than 40%).\n\n3. Antegrade flow both vertebral arteries." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: left lower quadrant\nFluid: 600 cc of clear, yellow fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology, cytology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 600 cc of fluid were removed and sent for requested analyses." + }, + { + "input": "Targeted ultrasound exam of the left breast was performed in the area of\nconcern as indicated by the patient. At 10 o'clock position, 4 cm from the\nnipple, there is a 0.5 x 0.3 x 0.5 cm round anechoic mass with circumscribed\nmargins, a single thin internal septation and no internal vascularity. This is\nconsistent with a cyst.", + "output": "0.5 cm left breast cyst at 10:00 corresponding to the area of concern as\nindicated by the patient, for which no further imaging followup is warranted\nat this time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Left inguinal adenopathy.", + "output": "Ultrasound-guided biopsy of left inguinal lymph node." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has significant heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 117, 134, and 101 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 47 cm/sec.\nThe ICA/CCA ratio is 1.9.\nThe external carotid artery has peak systolic velocity of 84 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 52 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 66, 64, and 67 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 80 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Significant heterogeneous atherosclerotic plaque in the right ICA\nresulting in 40-59 percent stenosis.\n\n2. Mild heterogeneous atherosclerotic plaque in the left ICA resulting in\nless than 40% stenosis." + }, + { + "input": "RIGHT:\nMild calcified plaque is seen in the right carotid bulb and at the origin of\nthe right ICA and ECA..\nThe peak systolic velocity in the right common carotid artery is 91 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 96, 92, and 116 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.27.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nIntimal thickening is seen in the left common carotid artery.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid left internal carotid artery\nare 92, 108. Elevated velocity measuring up to 165 cm/sec is seen only in the\ndistal portion of the left ICA which could indicate a moderate stenosis\n(40-60%) or could be related to tortuosity.. The peak end diastolic velocity\nin the left internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 1.95.\nThe external carotid artery has peak systolic velocity of 108 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Borderline peak velocity in the right ICA however no hemodynamically\nsignificant stenosis identified. Mild plaque is seen at the origin of the\nright ICA.\n2. Intimal thickening in the left common carotid artery. No hemodynamically\nsignificant stenosis is seen at the bifurcation on the left however in view of\nhigh velocity in the distal left ICA a follow-up ultrasound in ___ year is\nrecommended.\n\nRECOMMENDATION(S): Follow-up carotid ultrasound in ___ year recommended." + }, + { + "input": "RIGHT:\nTrace calcified plaque is seen in the right carotid bulb.\nThe peak systolic velocity in the right common carotid artery is 82 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 73, 92, and 130 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 1.13.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nMinimal intimal thickening is seen in the left common carotid artery..\nThe peak systolic velocity in the left common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 75, 107, and 122 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 37 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis identified at the proximal ICA\nbilaterally. Mildly elevated velocities are again noted very distally in the\nICA bilaterally. Follow-up ultrasound in ___ years is suggested to assess\nstability." + }, + { + "input": "Again seen is isoechoic ill-defined mass measuring at least 1.5 x 2.1 cm\nwithin the right buttock subcutaneous tissue above the musculature, which was\ntargeted for core needle biopsy.", + "output": "Technically successful ultrasound-guided core needle biopsy the right buttock\nmass. Samples were sent to cytology, pathology and culture for further\nanalysis." + }, + { + "input": "Preprocedure ultrasound demonstrates a 5.5 x 1.7 x 4.2 cm fluid collection in\nthe ___ o'clock right breast. Additional smaller fluid collections are seen\nin the right breast ___ o'clock position and left breast 9 to 10 o'clock\nposition.", + "output": "Bilateral fluid collections, greater on the right.\n\nRECOMMENDATION: Ultrasound guided aspiration will be performed of the right\ncollection with fluid to be sent to microbiology.\n\nNOTIFICATION: This was discussed with Dr. ___ at the time of the exam.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Preprocedure ultrasound demonstrates a 5.5 x 1.7 x 4.2 cm fluid collection in\nthe ___ o'clock right breast. Additional smaller fluid collections are seen\nin the right breast ___ o'clock position and left breast 9 to 10 o'clock\nposition.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: Dr. ___, Fellow. The procedure was supervised by Dr.\n___, Attending.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 16-gaugeneedle was advanced into the fluid collection and\n8cc dark red fluid aspirated. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to microbiology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided aspiration of right breast 9 o'clock fluid\ncollection. Microbiology is pending. Standard post care instructions were\nprovided to the patient." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n103/41 cm/sec in its proximal portion, 109/39 cm/sec in its mid portion, and\n107/30 sec cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n74/25 cm/sec.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery has peak systolic velocity of 60 C cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.4.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n73/22 cm/sec in its proximal portion, 80/28 cm/sec in its mid portion, and\n84/30 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 76/28\ncm/sec.\nThe external carotid artery has peak systolic velocity of 68 cm/sec.\nThe vertebral artery has peak systolic velocity of 77 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.1.", + "output": "1. Mild heterogeneous plaque involving the proximal right and left internal\ncarotid arteries. However, no hemodynamically significant stenoses noted on\neither side (less than 40%).\n\n2. Normal flow both vertebral arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 81 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 48, 70, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.84.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 80, 83, and 79 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.99.\nThe external carotid artery has peak systolic velocity of 83 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Normal carotid ultrasound." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 65 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 58, 59, and 80 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 71 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 109, 69, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 58 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "< 40% stenosis of the right internal carotid artery.\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\n\nCC and lateral magnification views of the left breast were compared to prior\nstudy from ___. There is a cluster of amorphous microcalcifications\nin the upper-outer left breast spanning approximately 9 mm. There is a single\nslightly larger microcalcification which is seen lateral and inferior to this\ncluster which appears to change in configuration on multiple views however it\nis unclear whether it belongs to the same group of microcalcifications and may\nrepresent milk of calcium.\n\nThe previously noted 7 mm asymmetry in the posterior central right breast,\ndoes not persist, and is felt to have represented a summation artifact.\n\nTARGETED RIGHT BREAST ULTRASOUND: Targeted right breast ultrasound at the 9\no'clock and 3 o'clock position, 2-10 cm from the nipple was performed. There\nis no ultrasound correlate for the 7 mm asymmetry seen on prior mammogram from\n___. As seen on today's mammogram, the finding is felt to represent\nsummation artifact.", + "output": "1. Amorphous group of microcalcifications in the upper outer left breast.\nBiopsy is recommended. The finding is amenable to stereotactic core biopsy.\n2. No mammographic or sonographic correlate for previously seen 7 mm asymmetry\nin the right central posterior breast and represents summation artifact.\n\nRECOMMENDATION: Stereotactic core biopsy of the left breast.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\nFindings were notified to Dr. ___ e-mail.\n\nFINAL ASSESSMENT BI-RADS: 4B Suspicious - moderate suspicion for\nmalignancy." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\n\nCC and lateral magnification views of the left breast were compared to prior\nstudy from ___. There is a cluster of amorphous microcalcifications\nin the upper-outer left breast spanning approximately 9 mm. There is a single\nslightly larger microcalcification which is seen lateral and inferior to this\ncluster which appears to change in configuration on multiple views however it\nis unclear whether it belongs to the same group of microcalcifications and may\nrepresent milk of calcium.\n\nThe previously noted 7 mm asymmetry in the posterior central right breast,\ndoes not persist, and is felt to have represented a summation artifact.\n\nTARGETED RIGHT BREAST ULTRASOUND: Targeted right breast ultrasound at the 9\no'clock and 3 o'clock position, 2-10 cm from the nipple was performed. There\nis no ultrasound correlate for the 7 mm asymmetry seen on prior mammogram from\n___. As seen on today's mammogram, the finding is felt to represent\nsummation artifact.", + "output": "1. Amorphous group of microcalcifications in the upper outer left breast.\nBiopsy is recommended. The finding is amenable to stereotactic core biopsy.\n2. No mammographic or sonographic correlate for previously seen 7 mm asymmetry\nin the right central posterior breast and represents summation artifact.\n\nRECOMMENDATION: Stereotactic core biopsy of the left breast.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\nFindings were notified to Dr. ___ e-mail.\n\nFINAL ASSESSMENT BI-RADS: 4B Suspicious - moderate suspicion for\nmalignancy." + }, + { + "input": "Targeted ultrasound of the left breast at 12 o'clock 8-10 cm from the nipple\nat the area of ecchymosis, at the site of the stereotactic biopsy,\ndemonstrates a 3.4 cm by a 4 cm x 1.7 cm hypoechoic collection with internal\nechogenicity consistent with hematoma.\n\nScanning around the areolar and retroareolar region from 10 o'clock to 3\no'clock demonstrates skin thickening and increased echogenicity of the\nunderlying parenchyma. There is no underlying abscess or fluid collection for\ndrainage.", + "output": "1. Findings consistent with mastitis, surrounding the nipple and superior to\nthe nipple. No underlying abscess.\n\n2. Post biopsy hematoma.\n\nRECOMMENDATION: Consultation with the Breast Care ___ antibiotics.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 35 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "Survey view of the transplanted kidney shows no hydronephrosis or perinephric\ncollection.", + "output": "Sonographic guidance for biopsy of the right lower quadrant transplant kidney\nby nephrologist." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 78.3 cm/s / 21.1 cm/s\nCCA Distal: 67.1 cm/s / 21 cm/s\nICA ___: 64 cm/s / 25.9 cm/s\nICA Mid: 78.4 cm/s / 34.5 cm/s\nICA Distal: 63.2 cm/s / 26.5 cm/s\nECA: 105 cm/s\nVertebral: 27.7 cm/s\n\nICA/CCA Ratio: 1.17\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 94.4 cm/s / 28.5 cm/s\nCCA Distal: 81.2 cm/s / 22 cm/s\nICA ___: 61.9 cm/s / 23.7 cm/s\nICA Mid: 90.4 cm/s / 35.9 cm/s\nICA Distal: 68.1 cm/s / 31.9 cm/s\nECA: 126 cm/s\nVertebral: 25.9 cm/s\n\nICA/CCA Ratio: 1.11\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Targeted ultrasound of the left posterior neck was performed, which\ndemonstrated an enlarged, heterogeneous lymph node measuring 2.2 x 1.6 cm with\npartial solid and cystic components, corresponding to the previously seen\nlymph node on ___ PET-CT from ___.", + "output": "Technically successful ultrasound-guided core biopsy of left cervical lymph\nnode. Specimens were sent for pathology, cytology, and flow cytometry per\nlymphoma protocol, as well as culture." + }, + { + "input": "Complex fluid collection in the right hemipelvis similar in size to prior\nultrasound and CT studies. However, the collection is now more liquified.", + "output": "Successful US-guided transvaginal aspiration of pelvic abscess, removing 44 cc\npurulent fluid. A sample was sent for microbiology evaluation." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nCircumscribed 3 mm oval nodule in the lower inner left breast as seen on prior\nexam (___). No suspicious grouped calcifications or areas of\nunexplained architectural distortion.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the left breast was performed and compared to the\nprevious exam performed on ___. Targeted ultrasound of the left\nbreast demonstrates a well-circumscribed hypoechoic 3 mm cyst at the 8:30\nposition approximately 6 cm from the nipple, smaller in size and without\ndebris as seen on previous study.", + "output": "No mammographic or sonographic evidence for malignancy. Interval decrease in\nsize of left breast cyst.\n\nRECOMMENDATION: Resume Annual screening mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nCircumscribed 3 mm oval nodule in the lower inner left breast as seen on prior\nexam (___). No suspicious grouped calcifications or areas of\nunexplained architectural distortion.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the left breast was performed and compared to the\nprevious exam performed on ___. Targeted ultrasound of the left\nbreast demonstrates a well-circumscribed hypoechoic 3 mm cyst at the 8:30\nposition approximately 6 cm from the nipple, smaller in size and without\ndebris as seen on previous study.", + "output": "No mammographic or sonographic evidence for malignancy. Interval decrease in\nsize of left breast cyst.\n\nRECOMMENDATION: Resume Annual screening mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 130 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 93, 88, and 67 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 30\ncm/sec.\nThe ICA/CCA ratio is 0.73.\nThe external carotid artery has peak systolic velocity of 115 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild homogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 102 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 80, 80, and 90 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 34\ncm/sec.\nThe ICA/CCA ratio is 0.88.\nThe external carotid artery has peak systolic velocity of 100 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA stenosis <40%\nLeft ICA stenosis <40%" + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n Bilateral subpectoral intact saline implants noted. A triangular BB marks\narea of pain. There is no discrete mass underlying the BB. There are no\nspiculated masses suspicious grouped microcalcifications or areas of\narchitectural distortion. Benign coarse calcifications are noted in the right\nbreast. No significant interval change.\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. \nThe left breast was scanned over the area of pain which is at 3 o'clock 5-7 cm\nfrom the nipple. No discrete solid or cystic mass was seen underlying the\narea of pain.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Final disposition of pain should be based on clinical\nevaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is no appreciable plaque or wall thickening involving either carotid\nsystem. The peak systolic velocities as well as the ICA to CCA ratios are\nnormal bilaterally. There is normal antegrade flow involving both vertebral\narteries.", + "output": "Normal duplex and color Doppler assessment of both carotid systems." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses. There are bilateral subpectoral silicone implants.\n\nThe left retroareolar region and nipple are unremarkable.\n\nThere is an oval circumscribed mass in the right lateral breast measuring 1.3\ncm. There are no associated microcalcifications.\n\nBoth breasts demonstrate bilateral benign appearing calcifications similar to\nthe prior studies.\n\nBilateral breast ultrasound was performed. Scanning of the left retroareolar\nregion is unremarkable. Scanning of the right upper outer quadrant from 12:00\nwas performed. At 10 o'clock 9 cm from the nipple, there is an oval macro\nlobulated hypoechoic circumscribed mass measuring 1.3 cm x 1.1 cm x 0.7 cm.\nThis is without dominant vascularity or posterior features. This is seen along\nthe anterior margin of the breast parenchyma and correlates to the\nmammographic finding. The patient's breast implant is seen. The right axilla\nwas scanned and is without adenopathy.", + "output": "1. No evidence of left breast malignancy. There is no mammographic or\nultrasound explanation for the patient's focal pain.\n\n2. Right breast mass at 10 o'clock measuring 1.3 cm, probably a\nfibroadenoma.\n\nRECOMMENDATION: Ultrasound-guided core biopsy of the right breast 10 o'clock\nmass for definitive pathology.\n\nNOTIFICATION: Findings were reviewed with the patient at the time of the\nultrasound. We discussed the options of six-month followup vs core biopsy for\ndefinitive pathology. The patient prefers the later option. The patient was\ngiven information to schedule a biopsy appointment. The findings were also\nreviewed by telephone later same day, with Dr. ___ nurse, ___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Ultrasound of right breast at 10 o'clock, 21 cm from the nipple, 2 o'clock 6\ncm from nipple, an 10 o'clock 9 cm from the nipple. Scanning at 10 o'clock 21\ncm from nipple was performed. This seems to be beyond the margin of the breast\nand is along the lateral chest wall where there are no solid or cystic masses.\nScanning at 2 o'clock 6 cm from the nipple there are no solid or cystic\nmasses. Scanning at 10 o'clock 9 cm from nipple shows a hypoechoic solid\nbenign-appearing mass measuring 1.5 cm x 1.3 cm. This is similar to what was\nseen on previous sonography of ___. Ultrasound-guided core biopsy of\nthis mass was advised. The patient was given a slip to facilitate scheduling\nthe procedure", + "output": "Solid mass at 10 o'clock 9 cm from the nipple\n\nNormal ultrasound at 10 o'clock 21 cm from the nipple and at ultrasound-guided\ncore biopsy of the solid mass 2 o'clock 6 cm from the nipple\n\nRECOMMENDATION: Ultrasound-guided core biopsy at 10 o'clock, 9 cm from the\nnipple\n\nNOTIFICATION: Results and recommendations discussed with the patient\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Right breast mass at 10 o'clock.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD ___, NP. The procedure was\nsupervised by ___, MD (___).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a first, 1 sample was made with a 16 gauge biopsy device.\nThen, a 13 gaugecoaxial needle was placed adjacent to the lesion and using a\n14-gauge Bard spring-loaded biopsy device, 4 cores were obtained. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications. There implant appeared intact after\nthe procedure.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of right breast mass. Pathology\nis pending. The patient expects to hear the pathology results from Dr.\n___ In ___ business days. Standard post care instructions were provided\nto the patient." + }, + { + "input": "Right breast mass at 10 o'clock.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD ___, NP. The procedure was\nsupervised by ___, MD (___).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a first, 1 sample was made with a 16 gauge biopsy device.\nThen, a 13 gaugecoaxial needle was placed adjacent to the lesion and using a\n14-gauge Bard spring-loaded biopsy device, 4 cores were obtained. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications. There implant appeared intact after\nthe procedure.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of right breast mass. Pathology\nis pending. The patient expects to hear the pathology results from Dr.\n___ In ___ business days. Standard post care instructions were provided\nto the patient." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 3 18-gauge core biopsy passes were made. \nThe sample was provided to the on-site cytologist who indicated an adequate\nsample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 13\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 3, with specimen provided to\nthe cytologist." + }, + { + "input": "Focused ultrasound of the upper right breast was performed from ___ o'clock\nbetween 1 and 10 cm from the nipple in the area of the mammographic finding. \nThe parenchyma is homogeneously dense and fibroglandular. In the 12 o'clock\nlocation 2 cm from the nipple but far posteriorly against the chest wall,\nthere is a 1 x 0.5 x 1 cm oval, circumscribed, parallel hypoechoic mass with\nlow-level internal echoes. There may be slight posterior acoustic enhancement\nalthough through transmission is difficult to show given the proximity to the\nchest wall. There is no internal vascularity. This could be a mildly\ncomplicated cyst versus a probably benign solid mass. This is good correlate\nin size, shape and location to the mammographic finding.", + "output": "There is a 1 cm oval mass with benign sonographic features in the 12 o'clock\nright breast 2 cm from the nipple far posteriorly which likely corresponds to\nthe mammographic finding. This could be a mildly complicated cysts versus a\nprobably benign solid nodule.\n\nRECOMMENDATION(S): Six-month ultrasound follow-up of this mass is recommended\nto ensure stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy who agrees with the plan, and she received written documentation of the\nrecommendations. She also expressed interest in risk assessment given her\nfather's breast cancer history and dense breast, and she will discuss this\nwith her referring clinician.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At the 12 o'clock position of the right breast approximately 2 cm from the\nnipple, there is an oval, circumscribed, hypoechoic mass measuring 1 x 0.5 x\n1.2 cm, stable compared to the prior examination which previously measured 1 x\n0.5 x 1 cm. Again, this is probably benign. No new suspicious abnormality is\nidentified.", + "output": "6 month stability of probably benign right breast mass. Recommend right\nbreast ultrasound in 6 months to ensure ___ year stability. The patient will\nalso be due for bilateral mammography at that time.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and right breast ultrasound\nin 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and diffusely\nnodular which lowers the sensitivity of mammography and could conceivably\nobscure detection of small masses. A 1.2 cm circumscribed mass in the central\nslightly upper right breast is unchanged since ___ continuing to favor\na benign finding. No architectural distortion or suspicious grouped\nmicrocalcifications are identified in either breast.\n\nUltrasound of the right breast in the area of concern on prior imaging at 12\no'clock, 2 cm from the nipple again demonstrates an oval, circumscribed,\nhypoechoic mass with no internal vascularity measuring 1 x 0.5 x 1 cm. This\nis unchanged since ___, and therefore continues to favor a benign\nprocess. Continued followup imaging in one year seems reasonable at this\ntime. If there is a need for more immediate diagnostic certainty,\nultrasound-guided aspiration/core biopsy could be performed.", + "output": "One year stability of probable benign right breast mass for which continued. \nOne year follow-up with mammogram and ultrasound seems reasonable at this\ntime.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and right breast ultrasound\nin one year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and diffusely\nnodular which lowers the sensitivity of mammography and could conceivably\nobscure detection of small masses. A 1.2 cm circumscribed mass in the central\nslightly upper right breast is unchanged since ___ continuing to favor\na benign finding. No architectural distortion or suspicious grouped\nmicrocalcifications are identified in either breast.\n\nUltrasound of the right breast in the area of concern on prior imaging at 12\no'clock, 2 cm from the nipple again demonstrates an oval, circumscribed,\nhypoechoic mass with no internal vascularity measuring 1 x 0.5 x 1 cm. This\nis unchanged since ___, and therefore continues to favor a benign\nprocess. Continued followup imaging in one year seems reasonable at this\ntime. If there is a need for more immediate diagnostic certainty,\nultrasound-guided aspiration/core biopsy could be performed.", + "output": "One year stability of probable benign right breast mass for which continued. \nOne year follow-up with mammogram and ultrasound seems reasonable at this\ntime.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and right breast ultrasound\nin one year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. There is a stable low-density\ncircumscribed mass in the superior central posterior breast unchanged\nmammographically.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the right breast at 12 o'clock\n3 cm from nipple demonstrates similar appearing hypoechoic mass measuring 1 x\n1.1 x 0.6 cm.", + "output": "No mammographic evidence of malignancy.\n\n___ year stability of a circumscribed right breast mass at 12 o'clock in keeping\nwith a benign process.\n\nRECOMMENDATION(S): Risk and age based screening.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. There is a stable low-density\ncircumscribed mass in the superior central posterior breast unchanged\nmammographically.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the right breast at 12 o'clock\n3 cm from nipple demonstrates similar appearing hypoechoic mass measuring 1 x\n1.1 x 0.6 cm.", + "output": "No mammographic evidence of malignancy.\n\n___ year stability of a circumscribed right breast mass at 12 o'clock in keeping\nwith a benign process.\n\nRECOMMENDATION(S): Risk and age based screening.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is minimal heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 73.9 cm/s / 14.1 cm/s\nCCA Distal: 56.7 cm/s / 17 cm/s\nICA ___: 78.1 cm/s / 19.7 cm/s\nICA Mid: 59.8 cm/s / 20.9 cm/s\nICA Distal: 71.3 cm/s / 24.3 cm/s\nECA: 54.4 cm/s\nVertebral: 43.1 cm/s\n\nICA/CCA Ratio: 1.38\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is minimal heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 97.3 cm/s / 15.4 cm/s\nCCA Distal: 75.4 cm/s / 16.3 cm/s\nICA ___: 61.5 cm/s / 16.5 cm/s\nICA Mid: 73.6 cm/s / 18.2 cm/s\nICA Distal: 73.1 cm/s / 22.3 cm/s\nECA: 58 cm/s\nVertebral: 49.1 cm/s\n\nICA/CCA Ratio: 0.98\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Minimal atherosclerotic plaque in bilateral carotid arteries without\nhemodynamically significant stenosis." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the bilateral axilla. Accessory breast tissue is visualized. No dominant\nmasses, suspicious microcalcifications, or unexplained architectural\ndistortions. The bilateral axilla were further evaluated with same-day\nultrasound.\n\nBREAST ULTRASOUND: Asymmetric accessory breast tissues visualized in the\nbilateral axilla. Specifically, no suspicious solid or cystic masses.", + "output": "Bilateral axillary accessory breast tissue. No evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nWithin the upper outer right breast, there is a partially circumscribed 2 cm\noval mass, better appreciated on same day ultrasound to correlate with a\nsimple cyst. Accessory breast tissue in the right axilla is unchanged\nrelative to prior examination. There is no area of unexplained architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast in\nthe region of concern as indicated by the patient. At the 10 o'clock position\napproximately 7 cm from the nipple, there is an oval well-circumscribed 2.2 x\n2.0 x 1.4 cm oval anechoic simple cyst without internal vascularity. There is\nno suspicious solid mass in the adjacent tissue.", + "output": "Palpable abnormality in the lateral right breast corresponds to a simple cyst,\nbest appreciated by ultrasound. No mammographic or sonographic evidence of\nmalignancy in the right breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nWithin the upper outer right breast, there is a partially circumscribed 2 cm\noval mass, better appreciated on same day ultrasound to correlate with a\nsimple cyst. Accessory breast tissue in the right axilla is unchanged\nrelative to prior examination. There is no area of unexplained architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast in\nthe region of concern as indicated by the patient. At the 10 o'clock position\napproximately 7 cm from the nipple, there is an oval well-circumscribed 2.2 x\n2.0 x 1.4 cm oval anechoic simple cyst without internal vascularity. There is\nno suspicious solid mass in the adjacent tissue.", + "output": "Palpable abnormality in the lateral right breast corresponds to a simple cyst,\nbest appreciated by ultrasound. No mammographic or sonographic evidence of\nmalignancy in the right breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound was performed in the area of clinical concern as directed\nby the patient. At the 10 o'clock position of the right breast 7 cm from the\nnipple, there is a 1.7 x 1.8 x 1.3 cm simple cyst which is slightly decreased\nin size in comparison to the prior study in corresponding to the area of\nclinical concern, which was targeted for aspiration.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the lesion and\napproximately 2 cc of straw-colored fluid was aspirated. The cyst resolved. \nThe fluid was discarded due to lack of suspicion. The needle was removed and\nhemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast cyst.", + "output": "Technically successful US-guided aspiration of the right breast cyst.\n\nFindings reviewed with the patient at the completion of the aspiration. Age\nand risk appropriate mammography is recommended.\n\nStandard post care instructions were provided to the patient." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nPreprocedure ultrasound marking for percutaneous renal biopsy was provided by\nradiologist, with the nephrology proceduralist present. The lower pole of the\nleft kidney was targeted and the skin marked appropriately.\n\nSEDATION: Please see Nephrology procedure note for details.", + "output": "Ultrasound marking for percutaneous left kidney biopsy performed by Nephrology\nservice." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 81.4 cm/s / 16.8 cm/s\nCCA Distal: 64 cm/s / 24 cm/s\nICA ___: 63.1 cm/s / 25.1 cm/s\nICA Mid: 55.4 cm/s / 23 cm/s\nICA Distal: 81.8 cm/s / 41.2 cm/s\nECA: 112 cm/s\nVertebral: 29.8 cm/s\n\nICA/CCA Ratio: 1.28\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 76.3 cm/s / 25.2 cm/s\nCCA Distal: 65.3 cm/s / 23.6 cm/s\nICA ___: 52.7 cm/s / 20.2 cm/s\nICA Mid: 79.1 cm/s / 35.2 cm/s\nICA Distal: 75.8 cm/s / 36.5 cm/s\nECA: 66.2 cm/s\nVertebral: 34.2 cm/s\n\nICA/CCA Ratio: 1.21\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "There is pneumobilia, likely secondary to prior stent. The liver demonstrates\nincreased echogenicity with no evidence of focal hepatic lesions. The\ngallbladder has been surgically removed and the CBD measures up to 1.0 cm,\nupper limit of normal diameter expected given cholecystectomy. The gallbladder\nfossa is grossly unremarkable. The portal vein is patent. Evaluation of the\npancreas is somewhat limited. Representative images of the right kidney are\nwithin normal limits.", + "output": "1. CBD measures up to 1 cm, upper limit of normal diameter expected given\ncholecystectomy. Grossly unremarkable gallbladder fossa.\n\n2. Pneumobilia, likely secondary to prior stent and/or sphincterotomy.\n\n3. Echogenic liver consistent with fatty deposition. Other forms of liver\ndisease and more advanced liver disease including significant hepatic\nfibrosis/cirrhosis cannot be excluded on this study." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 74, 106, and 78 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 33 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous atherosclerotic plaque\nwithin the proximal left internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 102 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 89, 148, and 100 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 127 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. No atherosclerotic plaque or hemodynamically significant stenosis within\nthe right carotid vasculature (previously reported as moderate stenosis-60-69%\nin ___.\n2. Unchanged appearance of moderate left proximal internal carotid\natherosclerotic plaque, which now results in mild stenosis (40-59%)." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the 11 o'clock 10 cm from\nnipple re-demonstrated a ovoid parallel superficial mass measuring 0.7 x 0.4 x\n0.7 cm containing hyperechoic component and unchanged since the prior studies.\nThe patient states this has been palpable to her for many years", + "output": "No mammographic evidence of malignancy.\n\nRight breast mass at 11 o'clock 10 cm from nipple has been stable on imaging\nsince ___ in keeping with a benign process.\n\nRECOMMENDATION(S): Risk and age based screening is recommended.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the 11 o'clock 10 cm from\nnipple re-demonstrated a ovoid parallel superficial mass measuring 0.7 x 0.4 x\n0.7 cm containing hyperechoic component and unchanged since the prior studies.\nThe patient states this has been palpable to her for many years", + "output": "No mammographic evidence of malignancy.\n\nRight breast mass at 11 o'clock 10 cm from nipple has been stable on imaging\nsince ___ in keeping with a benign process.\n\nRECOMMENDATION(S): Risk and age based screening is recommended.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Right lower extremity:\n\nPeak systolic velocities are as follows measured in cm/sec.:\n\nCommon femoral artery (proximal to distal): 98, 94\nProfundus femoris artery: 60\nSuperficial femoral artery (proximal to distal): 100, 74, 89, 153, 110, 207,\n156, 79\nPopliteal artery (proximal to distal): 46, 49, 51, 49, 56, 62\nAnterior tibial artery: Occluded\nPosterior tibial artery: Proximally occluded, distally 39 centimeters/second\nPeroneal artery: Occluded\nDorsalis pedis artery: Occluded", + "output": "Patent right femoral to popliteal artery stent with no significant stenosis\nidentified.\n\nThe proximal posterior tibial artery on the right is occluded however appears\nto reconstitute distally. The right peroneal, anterior tibial artery and\ndorsalis pedis artery are occluded." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 73 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 31 cm/s, 60 cm/s, and 69 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of76 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 61 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 43 cm/s, 58 cm/s, and 51 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 52.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Stable vascular calcifications are seen bilaterally.\nBREAST ULTRASOUND: Targeted examination to the area of clinical concern shows\nno abnormality.", + "output": "There is been no mammographic change in the appearance of either breast\nindicate malignancy. Also, there is no ultrasound abnormality in the area of\nclinical concern in the upper inner quadrant of the right breast. This seems\nto be this same region that was evaluated for a palpable finding in ___.\n\nRECOMMENDATION: Clinical followup is recommended despite any imaging\nabnormality.\n\nNOTIFICATION: Findings and recommendation(including rationale) for followup\nwere discussed in detail with the patient at the completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA single spot compression view of the left axilla demonstrates a BB marker\nwith an underlying 1.6 cm lobulated mass without associated calcifications. A\nsimilar-appearing masses partially included more superiorly in the same\nimaged. These most likely represent axillary lymph nodes. This was further\nevaluated with targeted breast ultrasound. Faint vascular calcifications are\nseen bilaterally. There is no dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications in either breast.\n\nLEFT AXILLARY ULTRASOUND: Targeted ultrasound was performed directly over the\npalpable lump in the left axilla. This corresponds to a benign lymph node.", + "output": "No specific evidence of malignancy. Benign left axillary lymph node\ncorresponding to the patient's palpable lump. The patient can return to\nroutine screening in ___ year.\n\nRECOMMENDATION(S): Return to routine screening in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA single spot compression view of the left axilla demonstrates a BB marker\nwith an underlying 1.6 cm lobulated mass without associated calcifications. A\nsimilar-appearing masses partially included more superiorly in the same\nimaged. These most likely represent axillary lymph nodes. This was further\nevaluated with targeted breast ultrasound. Faint vascular calcifications are\nseen bilaterally. There is no dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications in either breast.\n\nLEFT AXILLARY ULTRASOUND: Targeted ultrasound was performed directly over the\npalpable lump in the left axilla. This corresponds to a benign lymph node.", + "output": "No specific evidence of malignancy. Benign left axillary lymph node\ncorresponding to the patient's palpable lump. The patient can return to\nroutine screening in ___ year.\n\nRECOMMENDATION(S): Return to routine screening in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound exam of the right breast at 9 o'clock position, 5 cm from\nthe nipple, demonstrates a 0.7 by 0.6 x 0.3 cm oval circumscribed hypoechoic\nmass without internal vascularity. It appears unchanged in size and appearance\nsince ___ exam. No new cystic or solid mass is identified.", + "output": "Stable appearance of the right breast hypoechoic mass, since ___\nexam.\n\nRECOMMENDATION: A six-month ultrasound followup exam was recommended to the\npatient, however she prefers to pursue ultrasound-guided core biopsy of the\nlesion at this time.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her biopsy.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Pre-biopsy imaging confirms the presence of a 5 mm solid mass in the right\nbreast at 9 o'clock 5 cm from the nipple.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were explained in\ndetail to the patient, all her questions were answered and written informed\nconsent was obtained.\nTime-out certification: Performed using three patient identifiers at 10:57.\nAllergies and/or Medications: Reviewed prior to the procedure.\n\nClinicians: ___. ___, M.D. and ___, M.D.. The procedure was performed\nby ___, M.D. (Attending).\nDescription: Under sonographic guidance, using usual sterile technique and 1%\nlidocaine for local anesthesia, a 13-gaugecoaxial needle was placed adjacent\nto the lesion and using a 14-gauge Bard spring-loaded biopsy device, 4 core\nbiopsies of the right breast mass at 9 o'clock were obtained. Next, a\npercutaneous ribbon clip was deployed under sonographic guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\ndeployment and no significant hematoma.\n\nThe patient was discharged to home with standard post biopsy instructions.", + "output": "Technically successful US-guided core biopsy of a right breast mass at 9\no'clock. Pathology is pending.\n\nThe patient expects to hear the pathology results from ___\nin ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Pre-biopsy imaging confirms the presence of a 5 mm solid mass in the right\nbreast at 9 o'clock 5 cm from the nipple.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were explained in\ndetail to the patient, all her questions were answered and written informed\nconsent was obtained.\nTime-out certification: Performed using three patient identifiers at 10:57.\nAllergies and/or Medications: Reviewed prior to the procedure.\n\nClinicians: ___. ___, M.D. and ___, M.D.. The procedure was performed\nby ___, M.D. (Attending).\nDescription: Under sonographic guidance, using usual sterile technique and 1%\nlidocaine for local anesthesia, a 13-gaugecoaxial needle was placed adjacent\nto the lesion and using a 14-gauge Bard spring-loaded biopsy device, 4 core\nbiopsies of the right breast mass at 9 o'clock were obtained. Next, a\npercutaneous ribbon clip was deployed under sonographic guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\ndeployment and no significant hematoma.\n\nThe patient was discharged to home with standard post biopsy instructions.", + "output": "Technically successful US-guided core biopsy of a right breast mass at 9\no'clock. Pathology is pending.\n\nThe patient expects to hear the pathology results from ___\nin ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 106 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 59, 59, and 66 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 70 cm/sec.\nThe ICA/CCA ratio is 0.6.\nThe external carotid artery has peak systolic velocity of 97 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 49, 30, and 49 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 13 cm/sec.\nThe ICA/CCA ratio is 0.6.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "< 40% stenosis of the right internal carotid artery.\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "Transverse and sagittal images were obtained of the superficial tissues of the\nright breast under the nipple. At the 3 o'clock position, under the nipple of\nthe right breast, there is a 2.6 x 1.7 x 0.9 cm lobulated heterogeneous lesion\nwithout obvious internal vascularity. This lesion appears mildly increased\nsince the prior study in ___. Additionally, there is slight interval\nincrease in peripheral fluid component of the lesion with a more predominantly\nheterogeneous/solid central component.", + "output": "Mild interval increase of the previously seen lobulated heterogeneous lesion,\nnow measuring 2.6 cm, with slight interval increase in peripheral cystic\ncomponent of the lesion. As before, differential diagnosis includes abscess,\nduct ectasia with debris, or, less likely, malignancy.\n\nRECOMMENDATION(S): Recommend follow-up with the Breast Care Center.\n\nMild interval increase of the previously seen lobulated \nheterogeneous lesion, now measuring 2.6 cm, with slight interval increase in\nperipheral cystic component of the lesion. As before, differential diagnosis\nincludes abscess, duct ectasia with debris, or, less likely, malignancy.\nRecommend follow-up with the breast Care Center." + }, + { + "input": "Unchanged appearance of multiple enlarged right inguinal lymph nodes. Most\naccessible right inguinal lymph node was targeted for biopsy.", + "output": "Technically successful, ultrasound-guided, right inguinal lymph node biopsy\nusing lymphoma protocol." + }, + { + "input": "There is a oval well-circumscribed hypoechoic mass in the right breast at 11\no'clock 5 cm from the nipple measuring 4.6 x 2.2 x 3.5 cm with posterior\nacoustic enhancement and some central vascularity.", + "output": "Probable benign mass in the right breast could represent a fibroadenoma or\nphyllodes tumor. Ultrasound-guided core biopsy was later performed. Please\nsee separately dictated report.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Preprocedure imaging re- demonstrates a 4.2 x 2.0 x 4.0 cm oval hypoechoic\ncircumscribed mass in the right breast at 11 o'clock 5 cm from the nipple. \nThis was the target for preoperative bracketing wire localization.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained. The patient's\nallergies and medications were reviewed. A pre-procedure time-out was\nperformed using three patient identifiers, with confirmation of side and site.\n\nThe patient's right breast was scanned and the lesion was identified. Using\nstandard aseptic technique, and 10 cc of 1% lidocaine for local anesthesia, a\nlocalizing needle and subsequently a wire were placed along the superior and\ninferior margins of the lesion under ultrasound guidance. The target is\nlocated between the mid stiffeners and the distal tips.\n\nUNILATERAL DIGITAL POST-PROCEDURE MAMMOGRAM: Mammogram was deferred due to\nthe patient's age.\n\nThe patient tolerated the procedure well. There were no immediate\ncomplications. She was sent to the operating room with printed, annotated\nimages.", + "output": "Technically successful ultrasound bracketing wire localization of lesion in\nthe right breast at 11 o'clock." + }, + { + "input": "At the 11 o'clock position, approximately 6 cm from the nipple, over the area\nof clinical concern as indicated by the patient, there is a 3.7 x 1.8 x 4.1 cm\nwell-circumscribed, oval, hypoechoic mass which contains some internal\nvascularity. It has well delineated margins. There is no abscess or fluid\ncollection.", + "output": "1. A 4.1 cm hypoechoic oval vascular right breast mass. This could represent\na fibroadenoma or potentially phyllodes tumor.\n2. No abscess or fluid collection.\n\nRECOMMENDATION(S): Follow up with Breast Care Clinic is recommended as biopsy\nshould be considered.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy by Dr. ___. Findings discussed with Dr. ___ by Dr. ___\ntelephone on ___ at 9:21 pm, 5 minutes after discovery of the findings and\nsubsequently with the patient the following day. Patient has follow-up\nappointment in the Breast Care Center on ___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "There is a hypoechoic, vascular, ovoid mass measuring 3.5 x 2.2 x 4.6 cm at\nthe 11 o'clock position, 5 cm from the nipple.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ N.P. and ___ M.D. The procedure was\nsupervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nThe post procedure mammogram was deferred due to patient age.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Grayscale images of the abdomen were obtained. No frank ascitic fluid was\nseen in the abdomen or pelvis. Tiny pocket of interloop fluid in the right\nlower quadrant measuring 1.3 x 1.3 cm, is in keeping with physiological\namounts of peritoneal fluid.", + "output": "No ascites seen. Hence, a diagnostic or therapeutic paracentesis could not be\nperformed." + }, + { + "input": "Patent AV fistula anastomosis.\n\nDoppler flow seen in the left AV fistula to the level of the proximal axillary\nvein. No images beyond this point.\n\nSignificant increase in velocity at the mid portion of the fistula consistent\nwith significant stenosis.\n\nDoubling of velocity across the left axillary vein consistent with significant\nstenosis.\n\nHeterogeneous endovascular echogenicity distal to the axillary stenosis\nconcerning for clots.\n\nA 9 x 16 mm hypoechoic area anterior/superficial to the AV fistula anastomosis\nconcerning for a small hematoma from dialysis access. Thrombosed\npseudoaneurysm cannot be excluded given that this was not completely examined.", + "output": "Significant mid fistula and axillary vein stenoses.\n\nQuestionable axillary vein clots.\n\nHematoma/ thrombosed pseudoaneurysm anterior/ superficial to the AV fistula\nanastomosis.\n\nRECOMMENDATION(S): Consider targeted Doppler ultrasound to the swelling\nsuperficial to the AV fistula if pseudoaneurysm is clinically suspected.\n\nNOTIFICATION: Discussed over the phone with Dr. ___ by Dr. ___ at\n19:19." + }, + { + "input": "Right common carotid artery: Major branches of the right external carotid\nsystem are well visualized. The distal internal carotid and right middle\ncerebral arteries are well visualized. The right A1 segment is hypoplastic. \nThis is unchanged from the patient's prior angiogram. Vasospasm is noted in\nmultiple middle cerebral and anterior cerebral branches. Most significantly\nin the MCA candelabra and M2 superior division there is no evidence of dural\narteriovenous fistula or aneurysm. Venous phase is unremarkable.\n\nRight internal carotid artery: The distal right internal, middle cerebral, and\ndiminutive anterior cerebral arteries are well visualized. Again this\ninjection demonstrate moderate to severe vasospasm of the M2 superior division\nand proximal right anterior cerebral artery territories. Flow is preserved\ndistal to the vasospastic regions. There is no evidence of intracranial\naneurysm, vascular malformation, or arteriovenous fistula. The venous phase\nis unremarkable.\n\nRight internal carotid artery, follow-up after intra-arterial therapy:\nFollow-up angiography demonstrates some improvement in the previously\ndescribed vasospastic segments. Additionally in the no or region of the\nvessels there is post stenotic dilatation consistent with medication effect.\n\nLeft internal carotid artery: The distal left internal carotid, anterior\ncerebral, and middle cerebral arteries are well visualized. The left A1\nsegment is dominant supplying the majority of the bilateral anterior cerebral\nartery territory. Vasospasm is present in multiple branches of the left MCA\ncandelabra and distal anterior cerebral artery territories. Overall this is\nless prominent than the degree of vasospasm in the right hemisphere. Distal\nflow is preserved. There is no evidence of aneurysm or other vascular\nmalformation. The venous phase is unremarkable.\n\nLeft vertebral artery: The distal left vertebral, basilar, bilateral superior\ncerebellar, bilateral anterior inferior cerebellar, and bilateral posterior\ncerebral arteries are well visualized. Vessel caliber is smooth and tapering\nwithout evidence of vasospasm or atherosclerosis. There is no evidence of\naneurysm or other vascular malformation to explain the patient's subarachnoid\nhemorrhage. The venous phase is unremarkable.\n\nRight common femoral artery: The arteriotomy site enters proximal to the\ncommon femoral bifurcation. Vessel caliber is appropriate for Angio-Seal.", + "output": "Vasospasm in the bilateral anterior and middle cerebral artery territories,\nright greater than left.\n\nNo aneurysm or vascular malformation is seen to explain the patient's\nsubarachnoid hemorrhage." + }, + { + "input": "Right common femoral artery ultrasound: Micro puncture needle can be seen\nentering the lumen of the right common femoral artery. Follow-up views\ndemonstrate wire in position in the right common femoral artery.\n\nRight internal carotid artery: The distal right internal carotid, anterior\ncerebral, middle cerebral arteries are well visualized. Vessel caliber is\nsmooth and tapering. On three-dimensional rotational studies mild catheter\nassociated vasospasm is demonstrated. There is no evidence of aneurysm or\nother vascular malformation to explain the patient's subarachnoid hemorrhage. \nThe venous phase is unremarkable.\n\nLeft common carotid artery: The distal left internal carotid, anterior\ncerebral, middle cerebral arteries are well visualized. Major branches of the\nleft external carotid system are well visualized and patent. Vessel caliber\nis smooth and tapering without evidence of aneurysm or other vascular\nmalformation. An incidental note is made of an infundibulum at the origin of\nthe left posterior communicating artery. The venous phase is unremarkable.\n\nLeft vertebral artery: The distal left vertebral, basilar, bilateral superior\ncerebellar, and bilateral posterior cerebral arteries are well visualized. \nVessel caliber smooth and tapering. There is no evidence of aneurysm or other\nvascular lesion. The venous phase is unremarkable.\n\nRight common femoral artery: The sheath enters just proximal to the common\nfemoral bifurcation. There is no evidence of vessel injury. Vessel caliber\nis appropriate for Angio-Seal.", + "output": "No evidence of vascular lesion to explain the patient's subarachnoid\nhemorrhage.\n\nIncidental findings as above." + }, + { + "input": "Preprocedure ultrasound examination of the right upper quadrant showed a\ncollection in the gallbladder foci correlating with the collection seen\npreviously in the gallbladder fossa. Additionally 2 smaller collections were\nseen in the liver adjacent to the gallbladder fossa. The collection in the\ngallbladder foci of was selected for drainage.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ngallbladder fossa collection. Samplewas sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 69, 68, and 90 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 42 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 118 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 51, 75, and 88 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 44 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 72 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of significant stenosis in the internal carotid arteries\nbilaterally." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed from the right lower quadrant. Fluid samples\nwere sent to the laboratory as described above." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 30 cc of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 30 cc of fluid were removed." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no suspicious mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed over the right\nmastectomy scar with attention to the lateral aspect of the scar. No\nsuspicious solid or cystic mass was identified.", + "output": "No specific mammographic evidence of malignancy in the left breast. No\nsonographic abnormality in the right post mastectomy area of clinical concern.\nClinical followup is recommended for the in the area of concern along the\nlateral aspect of the mastectomy scar. Any decision to biopsy should be based\non clinical assessment.\n\nRECOMMENDATION(S): 1. Clinical followup for the area of concern in the\nlateral aspect of the mastectomy scar.\n2. Annual left breast mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound exam was performed in the area of concern based on CT\nfindings along the lateral margin of the mastectomy bed and inferior axilla,\nsoft tissue swelling trace amount of fluid is demonstrated, which most likely\nrelates to recent posttreatment changes. No worrisome cystic or solid mass is\nidentified. There is no drainable fluid collection.", + "output": "Soft tissue swelling and trace amount of fluid corresponds to CT finding dated\n___, most which most likely reflects posttreatment changes. No\nworrisome mass or drainable fluid collection. Further management of this\nfinding should be based on clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound exam was performed in the area of concern based on recent\nchest CT findings. Along the lateral mastectomy margin and the inferior right\naxilla, there is a small fluid collection measuring approximately 2.5 x 0.5\ncm, unchanged since ___ ultrasound exam. This is most likely\nreflective of expected post treatment changes.", + "output": "Stable appearance of the small fluid collection along the lateral margin of\nthe mastectomy bed, most suggestive of post treatment changes.\n\nRECOMMENDATION: Clinical followup is recommended\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nIn the left retroareolar region an oval circumscribed mass measures 6 mm. \nThere is no spiculated mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 12 o'clock in\nthe retroareolar region showed a round anechoic circumscribed lesion measuring\n0.5 x 0.5 cm that is benign, representing a dilated duct versus cyst.", + "output": "The previously described left retroareolar mass corresponds is benign. No\nevidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n16 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 16\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the right lower quadrant transplant kidney was\ntargeted and 4 x 16 gauge biopsy passes performed.\n\nSEDATION: The procedure was performed without sedation.", + "output": "Ultrasound guidance for percutaneous transplant kidney biopsy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBILATERAL BREAST ULTRASOUND: The right breast at 10 o'clock 2 cm from the\nnipple and left breast 2 o'clock 10 cm from the nipple and 1 o'clock 2 cm from\nthe nipple, in the areas of clinical concern as directed by the patient, were\nscanned and no abnormalities were identified.", + "output": "No evidence for malignancy.\n\nRECOMMENDATION(S): Clinical followup. Age and risk appropriate screening\nmammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA triangular marker is placed over the right upper breast in the area of pain\nas indicated by the patient. Dense breast tissue is identified in the region\nof the marker but no suspicious mass was identified. Ultrasound was performed\nfor further evaluation. Spot compression view of an asymmetry in the right\nupper breast on the MLO view demonstrates pliable normal fibroglandular\ntissue. Magnification views were performed for calcifications in the right\nupper outer breast. No distinct group was identified. There are scattered\nbenign calcifications that layer on the lateral view compatible with benign\nmilk of calcium.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of focal\npain as indicated by the patient. At 1 o'clock 5 cm from the nipple there is\nan anechoic simple cyst measuring 0.6 x 0.3 x 0.4 cm corresponding to the area\nof pain. No suspicious solid or cystic mass was identified.", + "output": "1. Simple cyst in the area of focal pain in the right breast. Clinical\nfollowup is recommended for breast pain.\n2. No specific evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Ultrasound imaging of the gallbladder demonstrates sludge and mild gallbladder\nwall thickening.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation.\n\nNOTIFICATION: Findings were discussed by Dr. ___ with Dr. ___ in person\non ___ at 5:40 ___, 10 min after procedure completion." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Vascular calcification is noted. There has been no\nchange.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses. Ectatic ducts are identified in\nthe retroareolar space.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Further management of the patient's pain should be based\non clinical assessment. Age and risk appropriate screening is advised.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Vascular calcification is noted. There has been no\nchange.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses. Ectatic ducts are identified in\nthe retroareolar space.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Further management of the patient's pain should be based\non clinical assessment. Age and risk appropriate screening is advised.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is no atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 110 cm/s / 17.6 cm/s\nCCA Distal: 77.4 cm/s / 21.7 cm/s\nICA ___: 62.1 cm/s / 18.2 cm/s\nICA Mid: 45.9 cm/s / 17.5 cm/s\nICA Distal: 55.9 cm/s / 19 cm/s\nECA: 129 cm/s\nVertebral: 69.8 Cm/s\n\nICA/CCA Ratio: 0.8\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is no atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 97.7 cm/s / 20.1 cm/s\nCCA Distal: 90.4 cm/s / 23.6 cm/s\nICA ___: 58.6 cm/s / 13 cm/s\nICA Mid: 91.2 cm/s / 23.7 cm/s\nICA Distal: 63.7 cm/s / 16.2 cm/s\nECA: 107 cm/s\nVertebral: 42.3 Cm/s\n\nICA/CCA Ratio: 1.01\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "Targeted ultrasound of the right breast at 9 o'clock 9 cm from the nipple\ndemonstrates a circumscribed hypoechoic oval mass oriented parallel to the\nchest wall measuring 1.3 x 0.6 x 1.2 cm (previously measuring 1.6 x 1.9 x 0.9\ncm). There is mild internal vascularity. This has decreased in size in\ncomparison to the prior study.", + "output": "Interval decrease in size of right breast mass at 9 o'clock.\n\nRECOMMENDATION(S): Given interval decrease in size and patient preference,\nthis mass was not targeted for ultrasound-guided core needle biopsy, and the\npatient preferred imaging follow-up.\nSonographic followup in ___ year is recommended.\n\nPlease see diagnostic mammogram report for same day mammogram interpretation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound at 9 o'clock, 9 cm from the nipple at the palpable mass\ndemonstrates an oval macro lobulated 1.9 x 1.6 x 1.0 cm well-circumscribed\nhypoechoic mass with internal septations. There is minimal prominence of the\nvascularity. There are no posterior features. Scanning of the right axilla\ndemonstrates normal-appearing lymph nodes.", + "output": "Probably benign 1.9 x 1.6 x 1.0 cm well-circumscribed hypoechoic mass, at 9\no'clock, likely a fibroadenoma.\n\nRECOMMENDATION: Six-month followup ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. We discussed the options of ultrasound followup as well as\nultrasound-guided core biopsy for definitive pathology. At this time the\npatient prefers ultrasound followup. She was given information to schedule\nthis appointment.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "There is a solid hypoechoic mass at 9 o'clock, 9 cm from the nipple measuring\n1.6 cm by 1.9 cm x 0.9 cm, slightly larger than it had been almost year ago. \nThere is internal color flow. A few small cystic spaces are present. The\nmass is parallel to the chest wall.\n\nA 3 by 3 by 2 mm similar appearing nodule is present adjacent to the larger\nnodule..", + "output": "As slightly enlarging solid masses with benign appearance.\n\nRECOMMENDATION: Ultrasound-guided core biopsy is scheduled for ___\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "The aorta is noted to be atherosclerotic. The aorta measures 2.2 cm in the\nproximal portion, 1.9 cm in mid portion and 1.6 cm in the distal abdominal\naorta. Wall-to-wall color flow is seen within aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.5 cm and the left common iliac artery\nmeasures 1.3 cm.\n\nThe right kidney measures 12.9 cm and the left kidney measures 13.0 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "Atherosclerotic aorta however no evidence of abdominal aortic aneurysm." + }, + { + "input": "The left soleus and lateral gastrocnemius muscles are intact. There is no\ndrainable collection identified. There is a region of focal discontinuity at\nthe midportion of the medial gastrocnemius muscle compatible with a moderate\ngrade partial tear. There is no hematoma. There is a small amount of fluid\ntracking along the fascia of the medial gastrocnemius muscle with laxity of\nthe fibers at the mid and distal portions of the medial gastrocnemius muscle. \nFurther characterization of the Findings could be performed with MRI if\nclinically desired.", + "output": "-Moderate grade partial tear medial gastrocnemius muscle at the level of the\nmid calf as described above.\n-No discrete hematoma or drainable collection identified at this time." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 1.3 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.3 L of fluid were removed." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild calcified heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 39 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 98, 72, and 56 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 2.5.\nThe external carotid artery has peak systolic velocity of 27 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the distal left common carotid artery is 167\ncm/sec. Proximally in the peak systolic velocity 69 centimeters/second.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 55, 44, and 37 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 13 cm/sec.\nThe ICA/CCA ratio is 0.79.\nThe external carotid artery has peak systolic velocity of 49 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is significant calcified plaque in the distal left common carotid\nartery.\n\nThere is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAn oval circumscribed mass in the left upper outer breast measuring 1.4 x 1.2\ncm persists on spot compression views. A partially circumscribed and\npartially obscured mass in the left lower inner breast measures 0.8 x 0.5 cm\nand persists on spot compression views. The previously described large\nasymmetry in the left outer breast at posterior depth, only appreciated on the\nCC view did not persist on spot compression views. The nodular asymmetries\nseen in the left inner breast, also did not persist on spot compression views.\nThere is no architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the outer and upper left\nbreast in the area of mammographic asymmetry in the mass and in the lower and\ninner inner left breast in the area of mammographic asymmetry and a mass was\nperformed. At 1 o'clock 4 cm from the nipple an oval circumscribed anechoic\nmass with posterior through transmission measures 1.3 x 0.6 x 1.3 cm which\ncorresponds to the left upper outer breast mass seen on mammography. At 6\no'clock 5 cm from the nipple in oval circumscribed anechoic mass with\nposterior through transmission and no internal vascularity measures 0.5 x 0.3\nx 0.8 cm which corresponds to the left lower inner breast mass seen on\nmammography. Scanning in the remainder of the breast showed normal dense\nbreast tissue. No suspicious cystic or solid masses were seen.", + "output": "The left breast masses correspond to simple cysts. The left breast\nasymmetries represent normal overlying breast tissue. No specific\nmammographic evidence of malignancy. Return to annual screening mammography\nis recommended.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nBenign-appearing coarse calcifications in both breasts are stable. Surgical\nclips in the left breast are unchanged. There is no dominant mass,\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned. Normal breast parenchyma is identified.\nNo solid or cystic mass is seen. Normal-appearing lymph node is seen in the\nleft lower axilla stable since prior examination.", + "output": "No abnormality identified at the site of clinical concern. No evidence of\nmalignancy.\n\nRECOMMENDATION: Annual mammography is recommended. Final disposition of any\npalpable concern should be based on clinical grounds.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nBenign-appearing coarse calcifications in both breasts are stable. Surgical\nclips in the left breast are unchanged. There is no dominant mass,\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned. Normal breast parenchyma is identified.\nNo solid or cystic mass is seen. Normal-appearing lymph node is seen in the\nleft lower axilla stable since prior examination.", + "output": "No abnormality identified at the site of clinical concern. No evidence of\nmalignancy.\n\nRECOMMENDATION: Annual mammography is recommended. Final disposition of any\npalpable concern should be based on clinical grounds.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissues are heterogeneously dense and nodular\nwhich lowers the sensitivity of mammography and could conceivably obscure a\nlesion. There are stable postsurgical changes in the slightly upper outer left\nbreast. A benign-appearing asymmetric left axillary node is again seen and\nappears to be in the region of concern as indicated by the patient. No\nsuspicious mass or cluster of suspicious microcalcification is seen in either\nbreast.\n\nUltrasound of the left breast from ___ o'clock 4-12 cm from the nipple in the\narea of concern as indicated by the patient was performed. No solid\nsuspicious mass or cystic lesion is seen. Note is made of a 2.3 x 0.5 x 0.9\ncm fatty replaced lymph node. However, this does not appear to correspond to\nthe area of concern as indicated by the patient. Therefore, any decision to\nbiopsy at this time should be based on the clinical assessment.", + "output": "No focal mammographic or sonographic abnormality identified in the left breast\nin an area of concern as indicated by the patient. Any decision to biopsy at\nthis time should be based on the clinical assessment. Stable left\npostsurgical changes.\n\nRECOMMENDATION: Annual mammography. Clinical followup.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses. There are no new dominant masses, suspicious\ncalcifications, or unexplained architectural distortion. Stable post biopsy\nclip is re- demonstrated in the upper inner right breast. Bilateral benign\nappearing calcifications with no suspicious group identified.\n\nRIGHT BREAST ULTRASOUND: Ultrasound reveals benign-appearing clustered simple\ncysts at 7 o'clock position in the right breast, 3 cm from the nipple with\ntotal greatest dimension of a 0.9 x 0.3 x 0.4 cm, stable when compared to\nprevious ultrasound from ___.", + "output": "No evidence of malignancy. Benign appearing simple cysts\n\nRECOMMENDATION: Return to yearly screening mammogram is recommended\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC BILATERAL MAMMOGRAM WITH CAD:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThe previously noted asymmetry in the outer right breast is not seen on the\ncurrent examination. A right breast percutaneous biopsy clip is noted. No\nabnormality is noted beneath the triangle pain marker or in either breast. A\nbreast intramammary lymph node is stable. No suspicious microcalcifications\nor unexplained architectural distortion is noted.\n\nRIGHT BREAST ULTRASOUND: The upper outer right breast was scanned in the area\nof clinical concern as indicated by the patient. No abnormality is\nidentified.\n\nAt 7 o'clock 3 cm from the nipple there is a stable group of cysts. These are\nunchanged since ___ and are benign.", + "output": "1. No imaging correlate for the area of clinical concern in the right breast.\n\n2. ___ year stability of the right breast cysts.\n\nRECOMMENDATION: 1. Further management for the area of clinical concern in\nthe right breast should be based on the clinical assessment.\n\n2. No additional followup for the right breast cysts at 7 o'clock is\nnecessary.\n\n3. Age and risk appropriate mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC BILATERAL MAMMOGRAM WITH CAD:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThe previously noted asymmetry in the outer right breast is not seen on the\ncurrent examination. A right breast percutaneous biopsy clip is noted. No\nabnormality is noted beneath the triangle pain marker or in either breast. A\nbreast intramammary lymph node is stable. No suspicious microcalcifications\nor unexplained architectural distortion is noted.\n\nRIGHT BREAST ULTRASOUND: The upper outer right breast was scanned in the area\nof clinical concern as indicated by the patient. No abnormality is\nidentified.\n\nAt 7 o'clock 3 cm from the nipple there is a stable group of cysts. These are\nunchanged since ___ and are benign.", + "output": "1. No imaging correlate for the area of clinical concern in the right breast.\n\n2. ___ year stability of the right breast cysts.\n\nRECOMMENDATION: 1. Further management for the area of clinical concern in\nthe right breast should be based on the clinical assessment.\n\n2. No additional followup for the right breast cysts at 7 o'clock is\nnecessary.\n\n3. Age and risk appropriate mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "Within the posterior aspect of the left upper arm, there is a fluid-filled\nstructure measuring 5.4 x 1.7 x 4.1 cm with internal heterogeneous debris and\nlacking internal vascularity. This structure appears to be marginated but has\nan irregular lobulated contour, and most likely represents a hematoma.", + "output": "5.4 cm fluid-filled structure with heterogeneous debris within the posterior\nleft upper arm, most likely representing a hematoma. Recommend follow-up to\nresolution." + }, + { + "input": "RIGHT:\nThe right great saphenous vein is patent. The vein measures 4 mm proximally\nand 3 mm distally. The right small saphenous vein is patent. The vein\nmeasures 3 mm proximally and 2mm distally. Distal calcifications are noted in\nthe small saphenous vein. Additional measurements are available on PACS.\n\nLEFT:\nThe left great saphenous vein is patent. The vein measures 5 mm proximally\nand 3 mm at the level of the knee. Varicosities are seen along the proximal\nand mid left GSV. The distal great saphenous vein and left small saphenous\nvein could not be assessed secondary to left leg bandage.", + "output": "Bilateral patent great saphenous veins. Patent right small saphenous vein. \nLimited evaluation of the left great saphenous vein below the knee and the\nleft small saphenous vein." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 85, 65, and 72 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.83.\nThe external carotid artery has peak systolic velocity of 146 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 125 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 83, 58, and 54 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.66.\nThe external carotid artery has peak systolic velocity of 140 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No atherosclerotic plaque or hemodynamically significant stenosis within the\ncarotid vasculature, bilaterally." + }, + { + "input": "Intraoperative ultrasound guidance was provided to Dr. ___ a\ndemarcation of the left and right hepatic lobes. There are at least three\nsub-5-mm echogenic foci identified within the right hepatic lobe, without\ncorrelates on prior CT. These are too small to be fully characterized. No\ndefinite right hepatic metastases were identified. Two left hepatic metastases\nwere identified along the surface and confirmed on US.\n\nPlease see the operative notes for further details.", + "output": "Intraoperative ultrasound examination of the liver. Please see the operative\nnote for further details." + }, + { + "input": "RIGHT:\nThere is no atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 89.5 cm/s / 13.7 cm/s\nCCA Distal: 90.1 cm/s / 17 cm/s\nICA ___: 45.5 cm/s / 12.9 cm/s\nICA Mid: 52.9 cm/s / 9.81 cm/s\nICA Distal: 62 cm/s / 14.1 cm/s\nECA: 74.4 cm/s\nVertebral: 50.6 cm/s\n\nICA/CCA Ratio: 0.69\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is noatherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 71.3 cm/s / 9.8 cm/s\nCCA Distal: 80.5 cm/s / 16.2 cm/s\nICA ___: 54.5 cm/s / 16.3 cm/s\nICA Mid: 63.1 cm/s / 17.6 cm/s\nICA Distal: 70.7 cm/s / 22.9 cm/s\nECA: 85.9 cm/s\nVertebral: 40.9 cm/s\n\nICA/CCA Ratio: 0.78\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Antegrade vertebral flow bilaterally.\nRight ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal heterogeneous atherosclerotic\nplaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n51/7 cm/sec in its proximal portion, 62/15 cm/sec in its mid portion, and\n87/16 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of 56/9\ncm/sec.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery has peak systolic velocity of 59 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.6.\n\nLEFT:\nThe left carotid vasculature has minimal heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n59/11 cm/sec in its proximal portion, 53/11 cm/sec in its mid portion, and\n89/23 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 68/8\ncm/sec.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery has peak systolic velocity of 42 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.3.", + "output": "1. Minimal heterogeneous atherosclerotic plaque in the bilateral proximal\ninternal carotid arteries, slightly increased compared to ___,\nthough still with with less than 40% stenosis bilaterally." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5 L of green-yellow fluid were removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.2 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential,\nculture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, yielding 4.2 L of clear, straw-colored ascitic fluid. Fluid\nsamples were submitted to the laboratory for cell count, differential, culture\nand cytology." + }, + { + "input": "Targeted ultrasound of the left medial inferior breast was performed. The\nentire left medial inferior breast was scanned. On harmonic imaging there was\na suggestion of a asymmetry measuring 1.4 cm in the left breast at 8 o'clock\n4 cms from the nipple, however it blends with the rest of the tissue on the\nradial plane, as well as on ___ ultrasound images, and represents breast\ntissue rather than a true mass. No other discrete solid or cystic mass is\nseen.", + "output": "No discrete mass corresponding to the asymmetry seen on the MRI. If\ndefinitive diagnosisis deemed necessary, MRI guided core biopsy is\nrecommended.\n\nRECOMMENDATION(S): If MRI guided core biopsy is not contemplated, a 6 month\nfollowup MRI is a reasonable option as recommended on the MRI report of ___. Findings and recommended were discussed with the ___\n___ ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "The upper-outer left breast was scanned with special attention paid to 2\no'clock 6 cm from the nipple and no abnormality was identified.", + "output": "No ultrasound abnormality correlating with the areas of clinical concern in\nthe left breast.\n\nRECOMMENDATION: Further management should be based on the clinical\nassessment.\n\nNOTIFICATION: This was discussed with the patient's time the exam.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. Innumerable echogenic liver lesions were identified. A lesion in\nthe right hepatic lobe was targeted for biopsy. A suitable approach for\ntargeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 7 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a single 18-gauge core biopsy sample was\nobtained. The sample was provided to the on-site cytologist who indicated an\nadequate sample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 1, with specimen provided to\nthe cytologist.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 11:10 a.m., up on study\ncompletion." + }, + { + "input": "DIGITAL DIAGNOSTIC BILATERAL MAMMOGRAM WITH CAD:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nLeft retroareolar nodularity is stable since at least ___. No new mass,\nsuspicious microcalcifications, or unexplained architectural distortion is\nseen in either breast.\n\nLEFT BREAST ULTRASOUND: At 1 o'clock 0 cm from the nipple, 2 stable masses\nare again noted. They currently measures 0.8 x 0.3 x 0.8 cm and 1.0 x 0.9 x\n0.4 cm. There is no internal vascularity.", + "output": "___ year stability of probably benign left breast retroareolar masses. \nAdditional one year followup is recommended at which time the patient will be\ndue for her annual mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC BILATERAL MAMMOGRAM WITH CAD:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nLeft retroareolar nodularity is stable since at least ___. No new mass,\nsuspicious microcalcifications, or unexplained architectural distortion is\nseen in either breast.\n\nLEFT BREAST ULTRASOUND: At 1 o'clock 0 cm from the nipple, 2 stable masses\nare again noted. They currently measures 0.8 x 0.3 x 0.8 cm and 1.0 x 0.9 x\n0.4 cm. There is no internal vascularity.", + "output": "___ year stability of probably benign left breast retroareolar masses. \nAdditional one year followup is recommended at which time the patient will be\ndue for her annual mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe left breast demonstrates 2 stable oval masses in the left retroareolar\nregion, less prominent compared to ___ and best seen on tomosynthesis slices.\nOtherwise, both breasts are without suspicious dominant mass, architectural\ndistortion or grouped microcalcification.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 1 o'clock 0 -1\ncm from the nipple demonstrates 2 stable oval circumscribed masses measuring\n0.7 x 0.3 x 0.6 cm and 0.8 x 0.4 x 0.8 cm. These are without dominant\nvascularity or posterior features. There is slightly smaller from the prior\nstudy.", + "output": "___ year stability of benign appearing left breast masses, likely fibroadenoma. \nNo specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening mammography with 3D tomosynthesis.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe left breast demonstrates 2 stable oval masses in the left retroareolar\nregion, less prominent compared to ___ and best seen on tomosynthesis slices.\nOtherwise, both breasts are without suspicious dominant mass, architectural\ndistortion or grouped microcalcification.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 1 o'clock 0 -1\ncm from the nipple demonstrates 2 stable oval circumscribed masses measuring\n0.7 x 0.3 x 0.6 cm and 0.8 x 0.4 x 0.8 cm. These are without dominant\nvascularity or posterior features. There is slightly smaller from the prior\nstudy.", + "output": "___ year stability of benign appearing left breast masses, likely fibroadenoma. \nNo specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening mammography with 3D tomosynthesis.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A - the breast tissues are predominantly fatty with minimal\nresidual fibroglandular tissue and thick septations. No suspicious mass,\narchitectural distortion or suspicious grouped microcalcifications are\nappreciated. There is a stable 0.7 cm well-circumscribed low-attenuation mass\nin the slightly lateral, anterior superior breast. In addition, there is a\nstable 0.6 cm bilobed low-attenuation mass in the posterior central breast. \nGiven stability, these favor benign findings.\n\nUltrasound of the entire retroareolar breast was undertaken 0-5 cm from the\nnipple. At 1 o'clock 0-1 cm from the nipple is identified a minimally dilated\nducts with a intraductal branching mass measuring 0.9 x 0.4 x 0.9 cm. This is\nfelt to correspond to the previously imaged mass in the retroareolar left\nbreast and the stable mass on mammography. Given stability, findings would\nfavor a benign process, possibly an intraductal papilloma. Given the\nassociated dilated duct, the possibility periductal mastitis is raised and\nthis could account for the new nipple inversion. Clinical correlation,\nhowever, is recommended. Options of clinical followup, surgical excision or\nfurther imaging with MRI were discussed with the patient as well as with\n___ NP in the Breast ___ as the patient is scheduled to be\nfurther evaluated clinically following completion of this evaluation. Any\ndecision to biopsy at this time and further management at this time should be\nbased on the clinical assessment.", + "output": "0.9 cm intraductal mass at 1 o'clock in the retroareolar left breast with\nassociated dilated duct favoring intraductal papilloma and possible periductal\nmastitis. Any decision to biopsy at this time and further management at this\ntime should be based on the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n The findings were discussed with ___, N.P. by ___,\nM.D. on the telephone on ___ at 11:05 am, 5 minutes after discovery of\nthe findings.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: A - the breast tissues are predominantly fatty with minimal\nresidual fibroglandular tissue and thick septations. No suspicious mass,\narchitectural distortion or suspicious grouped microcalcifications are\nappreciated. There is a stable 0.7 cm well-circumscribed low-attenuation mass\nin the slightly lateral, anterior superior breast. In addition, there is a\nstable 0.6 cm bilobed low-attenuation mass in the posterior central breast. \nGiven stability, these favor benign findings.\n\nUltrasound of the entire retroareolar breast was undertaken 0-5 cm from the\nnipple. At 1 o'clock 0-1 cm from the nipple is identified a minimally dilated\nducts with a intraductal branching mass measuring 0.9 x 0.4 x 0.9 cm. This is\nfelt to correspond to the previously imaged mass in the retroareolar left\nbreast and the stable mass on mammography. Given stability, findings would\nfavor a benign process, possibly an intraductal papilloma. Given the\nassociated dilated duct, the possibility periductal mastitis is raised and\nthis could account for the new nipple inversion. Clinical correlation,\nhowever, is recommended. Options of clinical followup, surgical excision or\nfurther imaging with MRI were discussed with the patient as well as with\n___ NP in the Breast ___ as the patient is scheduled to be\nfurther evaluated clinically following completion of this evaluation. Any\ndecision to biopsy at this time and further management at this time should be\nbased on the clinical assessment.", + "output": "0.9 cm intraductal mass at 1 o'clock in the retroareolar left breast with\nassociated dilated duct favoring intraductal papilloma and possible periductal\nmastitis. Any decision to biopsy at this time and further management at this\ntime should be based on the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n The findings were discussed with ___, N.P. by ___,\nM.D. on the telephone on ___ at 11:05 am, 5 minutes after discovery of\nthe findings.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated\nlarge amount of pleural fluid. A suitable target in the deepest pocket in the\nright posterior mid scapular line was selected for thoracentesis.\n\nLimited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of subhepatic ascites. A suitable target in the deepest pocket in the\nright lower quadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site for thoracentesis was selected and\nthe skin was prepped and draped in the usual sterile fashion. 1% lidocaine\nbuffered with sodium bicarbonate was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 3.1 L of serosanguineous fluid was removed.\n\nAfter that, Under ultrasound guidance, an entrance site for paracentesis was\nselected and the skin was prepped and draped in the usual sterile fashion. 1%\nlidocaine was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nmid abdomen and 0.75 L of straw-colored fluid was removed.\n\nThe patient tolerated the procedures well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Right thoracentesis with removal of 3.1 L serosanguineous fluid.\n2. Right mid abdomen paracentesis with removal of 0.75 L straw-colored fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated\nlarge amount of pleural fluid. A suitable target in the deepest pocket in the\nright posterior mid scapular line was selected for thoracentesis.\n\nLimited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of subhepatic ascites. A suitable target in the deepest pocket in the\nright lower quadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site for thoracentesis was selected and\nthe skin was prepped and draped in the usual sterile fashion. 1% lidocaine\nbuffered with sodium bicarbonate was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 3.1 L of serosanguineous fluid was removed.\n\nAfter that, Under ultrasound guidance, an entrance site for paracentesis was\nselected and the skin was prepped and draped in the usual sterile fashion. 1%\nlidocaine was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nmid abdomen and 0.75 L of straw-colored fluid was removed.\n\nThe patient tolerated the procedures well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Right thoracentesis with removal of 3.1 L serosanguineous fluid.\n2. Right mid abdomen paracentesis with removal of 0.75 L straw-colored fluid." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: 75 mcg fentanyl throughout the total intra-service time of 7\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Continuous vital sign monitoring by nursing staff during the\nprocedure.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is no suspicious dominant mass, architectural distortion or suspicious\ngrouped microcalcification. A few scattered benign calcifications are seen in\nthe right lateral breast and a few scattered benign calcifications are seen\nthroughout the left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right lateral inferior breast\nat the patient's area of palpable concern, at 8 o'clock 6 cm from the nipple,\ndemonstrates a a 1.5 x 1.1 x 1.8 cm irregular hypoechoic mass with\nheterogeneity and hyperechoic areas centrally, with a 0.5 mm cystic component\nalong the medial margin. There is prominence of the vascularity and there is\nno post closed shadowing. This may represent an area of lactational change,\nwith an adjacent galactocele.\n\nTargeted ultrasound of the left upper breast at the patient's clinical area of\nconcern, at 12 o'clock 7 cm from the nipple demonstrates a 0.9 x 0.6 x 0.7\ncyst with some thin internal septations. This is without dominant vascularity\nin demonstrates through transmission. This is likely a small galactocele.", + "output": "1.5 x 1.1 x 1.8 cm irregular hypoechoic mass in the right breast at 8 o'clock.\nThis may represent lactational changes or adenomas is changes with an adjacent\ngalactocele. Probable left breast galactocele.\n\nRECOMMENDATION: 3-month short interval followup ultrasound bilaterally. In\naddition, the patient and I discussed comparison with her priors which she\nwill attempt to obtain them.\n\nNOTIFICATION: Findings reviewed with the patient and her husband at the\ncompletion of the study. We discussed the options of biopsy as well as short\ninterval followup. At this time, as short interval followup is reasonable, the\npatient was given information to schedule a 3 month followup. Should the mass,\nhowever, continue to enlarge, ultrasound core biopsy would be recommended.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Right breast ultrasound: Targeted ultrasound the right breast was performed.\nThe previously seen probable benign hypoechoic lesion in the right breast at 8\no'clock 6 cm from the nipple is no longer seen and appears to have resolved in\nthe interval. A simple cyst measuring 2 mm was noted in the right breast at 8\no'clock 6 cm from the nipple.\n\nLeft breast ultrasound: Targeted ultrasound left breast was performed. In the\nleft breast at 12 o'clock 7 cm from the nipple is a well-circumscribed\nhypoechoic lesion measuring 0.7 x 0.5 x 0.6 cm with a contracted component\nwithin this appears to represent a galactocele or cyst with debris. It does\nnot show any central peripheral vascularity and shows some posterior acoustic\nenhancement.", + "output": "Stable lesion in the left breast at 12 o'clock likely a small galactocele.\n\nRECOMMENDATION: Six-month followup ultrasound recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 48 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 20, 28, and 38 cm/sec, respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 0.79.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 24, 50, and 48 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 0.87.\nThe external carotid artery has peak systolic velocity of 52 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": ">50% stenosis of the bilateral internal carotid arteries, by SRU consensus\nfindings." + }, + { + "input": "Targeted ultrasound exam of the right periareolar region was performed in the\narea of clinical concern. No suspicious cystic or solid mass identified.", + "output": "No sonographic correlate to right periareolar sensitivity/fullness.\n\nRECOMMENDATION: Further management of patient's right breast the sensitivity/\nfullness should be based on clinical assessment at this time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 40.8 cm/s / 11 cm/s\nCCA Distal: 75.3 cm/s / 30.3 cm/s\nICA ___: 103 cm/s / 30.6 cm/s\nICA Mid: 44.8 cm/s / 22.2 cm/s\nICA Distal: 69.1 cm/s / 36.8 cm/s\nECA: 59 cm/s\nVertebral: 62.9 cm/s\n\nICA/CCA Ratio: 1.37\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 75.2 cm/s / 15.9 cm/s\nCCA Distal: 63.7 cm/s / 18.7 cm/s\nICA ___: 33.9 cm/s / 12.2 cm/s\nICA Mid: 47.7 cm/s / 21 cm/s\nICA Distal: 60.9 cm/s / 26.5 cm/s\nECA: 57.5 cm/s\nVertebral: 22.7 cm/s\n\n\nICA/CCA Ratio: 0.96\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 1.4 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.4 L of fluid were removed." + }, + { + "input": "Tissue density: C - The breast tissues are heterogeneously dense and\nsomewhat nodular which lowers the sensitivity of mammography. There are\nbilateral postsurgical changes consistent with known reduction mammoplasty. A\nrounded asymmetry in the anteromedial left breast on the initial CC view is\nchangeable and compressible with differences in positioning and therefore is\nfelt to correspond to superimposed breast tissue. No suspicious mass or\ncluster of suspicious microcalcification is seen in either breast.\n\nUltrasound of the left breast from ___ o'clock 1-10 cm from the nipple and in\nthe left axilla was performed corresponding to the area of pain as indicated\nby the patient. No solid suspicious mass or cystic lesion is seen. Several\nbenign appearing axillary nodes are seen, the largest of which measured 1.1\ncm. Further management of the patient's symptoms at this time should be based\non the clinical assessment..\n\nUltrasound of the right breast from ___ o'clock o'clock 1-10 cm from the\nnipple and in the right axilla was performed corresponding to the area of pain\nas indicated by the patient. No solid suspicious mass or cystic lesion is\nseen. Several benign appearing axillary lymph nodes are seen with the largest\nmeasuring 0.7 cm. Further management of the patient's symptoms at this time\nshould be based on the clinical assessment..", + "output": "Bilateral postsurgical changes consistent with known reduction mammoplasty. \nNo focal mammographic or sonographic abnormality identified in either breast\nor axilla in the areas of discomfort as indicated by the patient. Further\nmanagement of the patient's symptoms at this time should be based on the\nclinical assessment.\n\nRECOMMENDATION: Annual screening mammography given strong family history for\nbreast cancer.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissues are heterogeneously dense and\nsomewhat nodular which lowers the sensitivity of mammography. There are\nbilateral postsurgical changes consistent with known reduction mammoplasty. A\nrounded asymmetry in the anteromedial left breast on the initial CC view is\nchangeable and compressible with differences in positioning and therefore is\nfelt to correspond to superimposed breast tissue. No suspicious mass or\ncluster of suspicious microcalcification is seen in either breast.\n\nUltrasound of the left breast from ___ o'clock 1-10 cm from the nipple and in\nthe left axilla was performed corresponding to the area of pain as indicated\nby the patient. No solid suspicious mass or cystic lesion is seen. Several\nbenign appearing axillary nodes are seen, the largest of which measured 1.1\ncm. Further management of the patient's symptoms at this time should be based\non the clinical assessment..\n\nUltrasound of the right breast from ___ o'clock o'clock 1-10 cm from the\nnipple and in the right axilla was performed corresponding to the area of pain\nas indicated by the patient. No solid suspicious mass or cystic lesion is\nseen. Several benign appearing axillary lymph nodes are seen with the largest\nmeasuring 0.7 cm. Further management of the patient's symptoms at this time\nshould be based on the clinical assessment..", + "output": "Bilateral postsurgical changes consistent with known reduction mammoplasty. \nNo focal mammographic or sonographic abnormality identified in either breast\nor axilla in the areas of discomfort as indicated by the patient. Further\nmanagement of the patient's symptoms at this time should be based on the\nclinical assessment.\n\nRECOMMENDATION: Annual screening mammography given strong family history for\nbreast cancer.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 84,82, and 103 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 93 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 109 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 59, 89, and 92 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.84.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Minimal atherosclerosis. Bilateral <40% stenosis." + }, + { + "input": "Limited preprocedure ultrasound once again demonstrated a distended\ngallbladder. Moderate amount of perihepatic free fluid was noted, with small\nand possibly nodular liver (poorly visualized given available sonographic\nwindows and patient positioning). There was no optimal transhepatic window\nfor tube placement. Therefore, the catheter was inserted through an anterior\napproach. Approximately 200 cc of bilious fluid was aspirated. Limited\npostprocedure ultrasound demonstrated decompression of the gallbladder and\nsatisfactory position of the drainage catheter.", + "output": "1. Successful ultrasound-guided placement of ___ pigtail catheter into\nthe gallbladder. Samples was sent for microbiology evaluation.\n2. Moderate ascites, possible nodular liver on this extremely limited\navailable windows. Underlying chronic liver disease/cirrhosis cannot be\nexcluded." + }, + { + "input": "LIVER: Evaluation of the liver liver suboptimal due to decreased acoustic\npenetration. Within these limits, the hepatic parenchyma appears echogenic,\nconsistent with hepatic steatosis. The contour of the liver is smooth. There\nis no focal liver mass. The main portal vein is patent with hepatopetal flow.\nThere is no ascites.\n\nBILE DUCTS: The gallbladder appears contracted. There is no intrahepatic\nbiliary dilation. The CBD measures 3 mm.\n\nGALLBLADDER: Multiple shadowing gallstones are seen within the gallbladder.\nThere is no evidence of pericholecystic fluid or gallbladder wall thickening.\n\nPANCREAS: Imaged portion of the pancreas appears within normal limits, without\nmasses or pancreatic ductal dilation, with portions of the pancreatic tail\nobscured by overlying bowel gas.\n\nSPLEEN: Normal echogenicity, measuring 9.6 cm.\n\nRETROPERITONEUM: Visualized portions of aorta and IVC are within normal\nlimits.", + "output": "1. Liver evaluation suboptimal due to decreased acoustic penetration. \nEchogenic liver consistent with steatosis. Other forms of liver disease and\nmore advanced liver disease including steatohepatitis or significant hepatic\nfibrosis/cirrhosis cannot be excluded on this study.\n2. Cholelithiasis without evidence of cholecystitis." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 15 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 12\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 67.4 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 53.8, 86.8, and 95.6 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 36.4 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 77.4 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 79.4 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 65.1, 58.0, and 64.4 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25.9 cm/sec.\nThe ICA/CCA ratio is 0.92.\nThe external carotid artery has peak systolic velocity of 78.7 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild atherosclerotic plaque at the bilateral carotid bulbs. No hemodynamically\nsignificant stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 20 gauge needle was advanced into the largest fluid pocket in the right\nlower quadrant and 10 cc of clear, straw-colored fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ performed the key components of the procedure and reviewed and\nagrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic paracentesis removing 10\ncc of clear, straw-colored ascitic fluid." + }, + { + "input": "BILATERAL DIGITAL MAMMOGRAM:\n\nTissue density: B - There are scattered areas of fibroglandular density\nThere is abnormal appearance to the is trauma with coarsening of trabeculation\nin the posterior depth right lower inner quadrant. This is in the area of the\nupper abdomen right breast and erythema and rash. No mass or distortion is\nseen on spot compression. There is no dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications in the left\nbreast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right lower breast was\nperformed. There is erythema and excoriation of the skin along the\ninframammary fold and upper abdomen. Patient reports to have experienced\nsimilar self limiting similar rash in the past. The breast parenchyma along\nthe inframammary fold appears more echogenic with thickening of the dermis up\nto 4 mm consistent with edema and inflammation. No focal fluid collection or\nabscess is identified. No solid or cystic mass is seen.", + "output": "No evidence of malignancy. Focal skin erythema and skin inflammation in the\nright inframammary region and upper abdomen without any breast abscess or\nmastitis.\n\nRECOMMENDATION(S): Age and risk of appropriate screening is recommended.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL DIGITAL MAMMOGRAM:\n\nTissue density: B - There are scattered areas of fibroglandular density\nThere is abnormal appearance to the is trauma with coarsening of trabeculation\nin the posterior depth right lower inner quadrant. This is in the area of the\nupper abdomen right breast and erythema and rash. No mass or distortion is\nseen on spot compression. There is no dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications in the left\nbreast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right lower breast was\nperformed. There is erythema and excoriation of the skin along the\ninframammary fold and upper abdomen. Patient reports to have experienced\nsimilar self limiting similar rash in the past. The breast parenchyma along\nthe inframammary fold appears more echogenic with thickening of the dermis up\nto 4 mm consistent with edema and inflammation. No focal fluid collection or\nabscess is identified. No solid or cystic mass is seen.", + "output": "No evidence of malignancy. Focal skin erythema and skin inflammation in the\nright inframammary region and upper abdomen without any breast abscess or\nmastitis.\n\nRECOMMENDATION(S): Age and risk of appropriate screening is recommended.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is a complex fluid collection containing both fluid and linear solid\nelements. The collection measures 5.1 cm x 2.4 cm by 5.0 cm. This\ncorresponds to the painful lump noted by the patient.", + "output": "Complex fluid collection may represent an abscess or infected galactocele.\n\nRECOMMENDATION: Ultrasound-guided drainage is pending for later this\nafternoon.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Left breast complex cystic mass/abscess at 2:00\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nTime-out certification: Performed using three patient identifiers. Allergies\nand/or Medications: Reviewed prior to the procedure.\nClinicians: ___, NP and ___, M.D.. T\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 16 gauge needle was advanced to the mass at 2:00 and 15\ncc of bloody pus was aspirated. The fluid sent to microbiology for analysis. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: To microbiology\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated left breast abscess", + "output": "Technically successful US-guided aspiration of the left breast abscess. Micro\npending. Return ___ for re-evaluation (patient out of town until then) and\nseek urgent care PRN.\n\nFindings reviewed with the patient at the completion of the aspiration.\nStandard post care instructions were provided to the patient." + }, + { + "input": "In the 2 o'clock position 5-6 cm from the nipple there is a large irregular\nhypoechoic mass measuring 3.7 x 2.0 x 5.4 cm, consistent with a large complex\nfluid collection with small amount of mobile debris and multiple loculations\nand septations. There is increased blood flow throughout this complex fluid\ncollection. There is a smaller 1.3 x 0.9 x 1.7 cm hypoechoic mass in the 3\no'clock position 5 cm from the nipple, connected to the larger mass,\nconsistent with a smaller complex fluid collection.", + "output": "Communicating complex fluid collections including a 5 cm in the 2 o'clock\nposition 5-6 cm from nipple and a 1.7 cm collection in the 3 o'clock position\n7 cm from nipple. Given predominantly solid appearance and multiple\nloculations and septations, surgical consultation for surgical drainage is\nrecommended.\n\nAdditionally, no recent screening mammograms are seen in our system. If the\npatient has not had a screening mammogram in the last year, bilateral\nmammogram is recommended.\n\nRECOMMENDATION(S): Surgical consultation for surgical drainage is\nrecommended. This was discussed with ___, NP by ___\n___, NP on ___ immediately following this examination. The\npatient was sent to Breast Care Center after this examination.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\n\nCCRL, CCRM, CCRL, CCRM, MLS, CCS, and MLOS views of the left breast show a 1.2\ncm spiculated mass in the upper outer quadrant. No suspicious\nmicrocalcifications identified.\n\nTargeted ultrasound in the upper outer quadrant of the left breast at 1\no'clock demonstrates a 1.4 x 1.6 x 1.3 cm hypoechoic mass with an irregular\nmargin and posterior shadowing.\n\nTargeted ultrasound of the left axilla showed a single concerning lymph node\nwith a 4 mm cortex. Additional lymph nodes with normal morphology were also\nidentified.", + "output": "1.6 cm mass with irregular margins in the upper outer left breast and a\nconcerning axillary lymph node for which ultrasound guided biopsy and fine\nneedle aspiration are recommended respectively.\n\nRECOMMENDATION: Ultrasound guided biopsy of the left breast mass and fine\nneedle aspiration of the suspicious axillary lymph node are recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 13:12 ___, 60 minutes after discovery of\nthe findings.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "1.5 x 1.2 x 1.7 cm spiculated solid mass at 1 o'clock position 5 cm from the\nnipple.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, FNA of left axillary lymph node was performed, 3 passes\nthrough the lymph node with 25 gauge needle were made, and the samples were\ncollected in CytoLyt. Next a 13-gaugecoaxial needle was placed adjacent to\nthe breast lesion and using a 12-gauge Celero vacuum-assisted biopsy device, 4\ncores were obtained. Next, a percutaneous dumbbell shaped clip was deployed\nunder ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion, and FNA of\nthe left axillary lymph node, pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ In\n___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "1.5 x 1.2 x 1.7 cm spiculated solid mass at 1 o'clock position 5 cm from the\nnipple.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, FNA of left axillary lymph node was performed, 3 passes\nthrough the lymph node with 25 gauge needle were made, and the samples were\ncollected in CytoLyt. Next a 13-gaugecoaxial needle was placed adjacent to\nthe breast lesion and using a 12-gauge Celero vacuum-assisted biopsy device, 4\ncores were obtained. Next, a percutaneous dumbbell shaped clip was deployed\nunder ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion, and FNA of\nthe left axillary lymph node, pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ In\n___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Right breast: Ultrasound of the 4 quadrants and retroareolar region\ndemonstrates normal-appearing breast parenchyma. Ultrasound of the right\naxilla demonstrates normal appearing right axillary lymph nodes.\nLeft breast: The known biopsy-proven cancer is identified in the 1 o'clock 5\ncm from the nipple. A linear echogenic focus is seen within this\ncorresponding to the biopsy marking clip. No additional lesions are seen in\nthe upper outer quadrant. Ultrasound of the the remaining portions of the\nbreast demonstrates normal-appearing breast parenchyma. The left axilla was\nnot evaluated as this was scanned on ___ and fine-needle aspiration\nof a lymph node was negative.", + "output": "Known biopsy proven malignancy in the left breast. No additional lesions\nidentified.\n\nRECOMMENDATION: Appropriate action for the known cancer should be undertaken.\n\nNOTIFICATION: Findings were discussed with the patient.\n\n\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.\n\nLeft internal carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral artery and the distal territories. \nThere is some cross-filling to the contralateral A2 via the anterior\ncommunicating artery but is modest. There is no evidence of aneurysm or AVM. \nThe venous phase is unremarkable. The right transverse sinus is dominant.\n\nRight internal carotid artery: Vessel caliber smooth and regular. There is\nopacification of the anterior middle cerebral arteries and their distal\nterritories. There is some flash filling of the anterior communicating artery\nbut no filling of the contralateral A2 segment. There is no evidence of\naneurysm or AVM. The venous phase is unremarkable.", + "output": "Normal intracranial vascular anatomy. Successful uncomplicated ___\n\nRECOMMENDATION(S):\n1." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 70.4 cm/s / 16.4 cm/s\nCCA Distal: 54.5 cm/s / 14.1 cm/s\nICA ___: 53.9 cm/s / 14.7 cm/s\nICA Mid: 53.4 cm/s / 11.1 cm/s\nICA Distal: 61 cm/s / 17.6 cm/s\nECA: 95 cm/s\nVertebral: 54.5 cm/s\n\nICA/CCA Ratio: 1.12\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 80.3 cm/s / 11.1 cm/s\nCCA Distal: 66.3 cm/s / 14.1 cm/s\nICA ___: 49.2 cm/s / 14.1 cm/s\nICA Mid: 65.1 cm/s / 14.1 cm/s\nICA Distal: 84.1 cm/s / 22.6 cm/s\nECA: 99.8 cm/s\nVertebral: 60.4 cm/s\n\nICA/CCA Ratio: 1.27\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Distended gallbladder.", + "output": "Successful US-guided placement of ___ pigtail catheter into the distended\ngallbladder samples was sent for microbiology evaluation." + }, + { + "input": "Transverse and sagittal images were obtained of the superficial tissues of the\nleft medial thigh, which demonstrate a 3.2 x 0.6 x 2.2 cm avascular\nheterogeneous collection. There is overlying subcutaneous edema.", + "output": "3.2 x 0.6 x 2.2 cm avascular heterogeneous collection in the superficial\ntissues of the left medial thigh." + }, + { + "input": "There is accessory breast tissue seen. No discrete cystic or solid mass or\nsuspicious abnormality is identified.", + "output": "No sonographic evidence of malignancy.\n\nRECOMMENDATION: Final disposition of any clinical findings should be based on\nclinical grounds.\n\nNOTIFICATION: Findings discussed with the patient.\n\nBI-RADS: 1 Negative." + }, + { + "input": "There is no evidence of fluid collection or soft tissue mass to suggest\nhematoma. Color flow and pulse Doppler assessment shows no evidence of\npseudoaneurysm or AV fistula. High velocity flow was noted in the right common\nfemoral artery, a to 433 cm/sec, consistent with arterial stenosis.", + "output": "No evidence of pseudoaneurysm, AV fistula or hematoma. High flow velocities\nconsistent with common femoral artery stenosis." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 88.5 cm/s / 19.3 cm/s\nCCA Distal: 62.7 cm/s / 17.6 cm/s\nICA ___: 72.1 cm/s / 25.8 cm/s\nICA Mid: 51.1 cm/s / 15.9 cm/s\nICA Distal: 50.8 cm/s / 12.7 cm/s\nECA: 53.9 cm/s\nVertebral: 51 cm/s\n\nICA/CCA Ratio: 1.15\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 99.7 cm/s / 19.3 cm/s\nCCA Distal: 76.2 cm/s / 21.1 cm/s\nICA ___: 126 cm/s / 39.3 cm/s\nICA Mid: 70.4 cm/s / 24.3 cm/s\nICA Distal: 56.8 cm/s / 20.9 cm/s\nECA: 112 cm/s\nVertebral: 41.6 cm/s\n\nICA/CCA Ratio: 1.65\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA 40-59% stenosis." + }, + { + "input": "The aorta is of normal caliber however there is extensive calcified\natherosclerotic plaque. The aorta has an undulating appearance however no\naneurysm is visualized. The iliac arteries are not aneurysmal.\n\nThe right kidney measures 10.6 cm and the left kidney measures 9.5 cm. Limited\nviews of the kidneys are unremarkable without hydronephrosis.", + "output": "Extensive atherosclerotic plaque seen within the aorta however no aneurysm\nidentified." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate to severe heterogeneous calcified\natherosclerotic plaque at the carotid bulb/bifurcation and in the proximal\naspect of the internal and external carotid arteries.\nThe right common carotid artery had peak systolic/diastolic velocities of\n73/18 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n160/39 cm/sec in its proximal portion, 158/41 cm/sec in its mid portion and\n83/19 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 155cm/sec.\nThe vertebral artery has peak systolic velocity of 63 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 2.2.\n\nLEFT:\nThe left carotid vasculature has moderate to severe heterogeneous calcified\natherosclerotic plaque at the carotid bulb/bifurcation and in the proximal\naspect of the internal and external carotid arteries.\nThe left common carotid artery had peak systolic/diastolic velocities of 49/14\ncm/sec.\nThe left internal carotid artery had peak systolic/diastolic velocities of\n214/65 cm/sec in its proximal portion, 72/25 cm/sec in its mid portion and\n46/17 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 195cm/sec.\nThe vertebral artery has peak systolic velocity of 68 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 4.4.", + "output": "1. Moderate to severe atherosclerotic plaque burden bilaterally at the carotid\nbifurcations as well as in the proximal aspects of the internal and external\ncarotid arteries.\n2. 60-69% stenosis of the right internal carotid artery.\n3. 70-79% stenosis of the left internal carotid artery." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque involving the right internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 128, 163, and 93 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 2.1.\nThe external carotid artery has peak systolic velocity of 145 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 55 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 47, 71, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 124 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate heterogeneous atherosclerotic plaque involving the right internal\ncarotid artery. There is elevation of the peak systolic velocity in the mid\nright internal carotid artery to a maximum of 163 cm/sec, indicating an\nunderlying 60-69% stenosis. No significant left ICA stenosis." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA well-circumscribed mass is noted in the left medial upper breast persists on\nadditional spot compression view. A mole marker was placed over a skin lesion\nand an mL spot-compression view was obtained and this appears to correspond to\na dermal lesion. There are no suspicious grouped microcalcifications or areas\nof architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound left breast was performed. In the\nleft breast at 10 o'clock 18 cm from nipple is a well-circumscribed hypoechoic\nlesion measuring 0.5 x 0.3 x 0.6 cm. In the dermal/subdermal region and\nappears consistent with a sebaceous cyst/epidermal inclusion cyst.", + "output": "Benign mass in the left breast consistent with a sebaceous cyst/epidermal\ninclusion cyst.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA well-circumscribed mass is noted in the left medial upper breast persists on\nadditional spot compression view. A mole marker was placed over a skin lesion\nand an mL spot-compression view was obtained and this appears to correspond to\na dermal lesion. There are no suspicious grouped microcalcifications or areas\nof architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound left breast was performed. In the\nleft breast at 10 o'clock 18 cm from nipple is a well-circumscribed hypoechoic\nlesion measuring 0.5 x 0.3 x 0.6 cm. In the dermal/subdermal region and\nappears consistent with a sebaceous cyst/epidermal inclusion cyst.", + "output": "Benign mass in the left breast consistent with a sebaceous cyst/epidermal\ninclusion cyst.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "The renal morphology is normal. Specifically, the cortex is of normal\nthickness and echogenicity, pyramids are normal, there is no\npelvi-infundibular thickening and renal sinus fat is normal. There is an\nextrarenal pelvis without blunting of the calices. Note is made of a 1.2 x 0.9\nx 1.2 cm simple appearing cyst in the mid to lower pole of the transplanted\nkidney.\n\nThe resistive index of intrarenal arteries ranges from 0.76 to 0.8, within the\nnormal range. Acceleration times and peak systolic velocities of the main\nrenal artery are normal. Vascularity is symmetric throughout the transplant.\nThe renal vein is patent and shows normal waveform. The right iliac artery\nand vein are patent.", + "output": "1. Extrarenal pelvis is noted within the transplanted kidney without blunting\nof the calices to suggest hydronephrosis.\n\n2. 1.2 cm simple appearing cyst in the transplanted kidney." + }, + { + "input": "At 11 o'clock 6 cm from the nipple there is a 0.7 x 0.2 x 0.9 cm hypoechoic\narea that is deep within the breast. There is no internal vascularity. It is\nnot clear whether this corresponds to the finding noted on MRI, however, given\nthat this is the only abnormality identified in this location and is in the\ngeneral vicinity of the MRI finding, ultrasound-guided core biopsy is\nrecommended. Further management will be based on the pathology results.", + "output": "Possible MRI correlate in the left breast at 11 o'clock 6 cm from the nipple.\n\nRECOMMENDATION: Ultrasound-guided core biopsy will be performed following\nthis exam.\n\nNOTIFICATION: Findings were directly discussed with the patient at the time\nof the study.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Again seen in the left breast at 11 o'clock 6 cm from the nipple is hypoechoic\nmass, please see same day imaging which immediately preceded this procedure.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___,\nM.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Sertera spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous echogenic heart shaped clip was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications. The implant was intact at the\nconclusion of the procedure.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending The patient expects to hear the pathology results from the breast\ncare center provider ___ ___ business days. Standard post care instructions\nwere provided to the patient. A ___ interpreter was used throughout the\nprocedure." + }, + { + "input": "Again seen in the left breast at 11 o'clock 6 cm from the nipple is hypoechoic\nmass, please see same day imaging which immediately preceded this procedure.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___,\nM.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Sertera spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous echogenic heart shaped clip was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications. The implant was intact at the\nconclusion of the procedure.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending The patient expects to hear the pathology results from the breast\ncare center provider ___ ___ business days. Standard post care instructions\nwere provided to the patient. A ___ interpreter was used throughout the\nprocedure." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Specifically, no new suspicious abnormality in the\nvicinity of radiopaque marker placed in the area of focal pain in the outer\nleft breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of pain\nwhich was without any discrete suspicious solid or cystic masses.", + "output": "No suspicious mammographic or sonographic findings to correlate to the\nreported pain in left breast.\n\nRECOMMENDATION(S): Clinical follow-up is recommended.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Specifically, no new suspicious abnormality in the\nvicinity of radiopaque marker placed in the area of focal pain in the outer\nleft breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of pain\nwhich was without any discrete suspicious solid or cystic masses.", + "output": "No suspicious mammographic or sonographic findings to correlate to the\nreported pain in left breast.\n\nRECOMMENDATION(S): Clinical follow-up is recommended.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The aorta measures 1.9 cm in the proximal portion, 1.6 cm in mid portion and\n1.6 cm in the distal abdominal aorta. There is mild calcified atherosclerotic\nplaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.9 cm and the left common iliac artery\nmeasures 1.0 cm.\n\nThe right kidney measures 9.8 cm and the left kidney measures 11.3 cm. Limited\nviews of the kidneys are unremarkable without hydronephrosis.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 1.2 L of blood tinged fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "Ultrasound-guided paracentesis. 1.2 L of blood-tinged fluid was removed from\nthe left lower quadrant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.5 L of clear, straw-colored ascitic fluid were removed.\nFluid samples were submitted to the laboratory for cell count, differential,\nand culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, yielding 1.5 of clear, straw-colored ascitic fluid. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of clear, straw-colored ascitic fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis, yielding 2\nL of clear, straw-colored ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: left lower quadrant\nFluid: 120 cc of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology and cytology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 120 cc of fluid were removed and sent for requested analysis." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious clustered\nmicrocalcification. There are pliable areas of breast tissue in the\nretroareolar region which are seen to be dilated ducts at 3 and 4 o'clock on\nsame date ultrasound. There is stable parenchymal tissue in the upper breast\non the ML view at middle depth with a layering calcification consistent with\nmilk of calcium in cysts, likely the microcysts at 11 o'clock 5 cm from the\nnipple. There are multiple benign appearing calcifications throughout the\nparenchyma without suspicious clusters. The medial breast is without discrete\nmass. Overall, the parenchymal pattern is similar to ___.\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the retroareolar region\ndemonstrates dilated ducts at 3 and 4 o'clock measuring up to 6 mm in diameter\nextending 1-2 cm. These are without intraluminal masses, accounting for the\nmammographic findings in the retroareolar region. At 11 o'clock 5 cm from the\nnipple there is a stable cluster of microcysts measuring 8 x 8 x 5 mm. The\nremainder of the left breast was scanned and is unremarkable.", + "output": "Six-month stability of clustered microcysts at 11 o'clock. Dilated ducts at 3\nand 4 o'clock. No evidence of malignancy.\n\nRECOMMENDATION: Six-month followup ultrasound at the time of the patient's\nannual diagnostic mammogram in ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious clustered\nmicrocalcification. There are pliable areas of breast tissue in the\nretroareolar region which are seen to be dilated ducts at 3 and 4 o'clock on\nsame date ultrasound. There is stable parenchymal tissue in the upper breast\non the ML view at middle depth with a layering calcification consistent with\nmilk of calcium in cysts, likely the microcysts at 11 o'clock 5 cm from the\nnipple. There are multiple benign appearing calcifications throughout the\nparenchyma without suspicious clusters. The medial breast is without discrete\nmass. Overall, the parenchymal pattern is similar to ___.\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the retroareolar region\ndemonstrates dilated ducts at 3 and 4 o'clock measuring up to 6 mm in diameter\nextending 1-2 cm. These are without intraluminal masses, accounting for the\nmammographic findings in the retroareolar region. At 11 o'clock 5 cm from the\nnipple there is a stable cluster of microcysts measuring 8 x 8 x 5 mm. The\nremainder of the left breast was scanned and is unremarkable.", + "output": "Six-month stability of clustered microcysts at 11 o'clock. Dilated ducts at 3\nand 4 o'clock. No evidence of malignancy.\n\nRECOMMENDATION: Six-month followup ultrasound at the time of the patient's\nannual diagnostic mammogram in ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere has been resolution of the previously described increased tissue density\nin the upper left breast on the MLO and ML views consistent with resolution of\nthe prior microcysts. There are bilateral benign appearing calcifications\nsimilar to the prior studies. There is no suspicious dominant mass,\narchitectural distortion or suspicious grouped microcalcification.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast at 11 o'clock\n5 cm from the nipple demonstrates resolution of the previously described\nclustered microcysts. Targeted ultrasound of the retroareolar region\ndemonstrates resolution of the previously dilated ducts at 3 and 4 o'clock.\nThe ducts are prominent measuring up to 2.5 mm in diameter. There are no\nintraductal lesions identified.", + "output": "No specific evidence of malignancy. Resolved microcysts in the left breast at\n11 o'clock. Decreased dilatation of left retroareolar ducts.\n\nRECOMMENDATION: Annual screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere has been resolution of the previously described increased tissue density\nin the upper left breast on the MLO and ML views consistent with resolution of\nthe prior microcysts. There are bilateral benign appearing calcifications\nsimilar to the prior studies. There is no suspicious dominant mass,\narchitectural distortion or suspicious grouped microcalcification.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast at 11 o'clock\n5 cm from the nipple demonstrates resolution of the previously described\nclustered microcysts. Targeted ultrasound of the retroareolar region\ndemonstrates resolution of the previously dilated ducts at 3 and 4 o'clock.\nThe ducts are prominent measuring up to 2.5 mm in diameter. There are no\nintraductal lesions identified.", + "output": "No specific evidence of malignancy. Resolved microcysts in the left breast at\n11 o'clock. Decreased dilatation of left retroareolar ducts.\n\nRECOMMENDATION: Annual screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nAdditional imaging confirms the presence of approximately 0.5 cm circumscribed\nmass in the slightly upper outer breast. This was further evaluated by\nultrasound. There is no architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast. At\n___ o'clock 5 cm from the nipple there is a 0.6 x 0.3 x 0.5 cm oval\ncircumscribed hypoechoic mass with internal vascularity which corresponds to\nthe mass on mammography.", + "output": "Indeterminate mass in the right breast for which ultrasound-guided biopsy is\nrecommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the right breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 10:02 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nAdditional imaging confirms the presence of approximately 0.5 cm circumscribed\nmass in the slightly upper outer breast. This was further evaluated by\nultrasound. There is no architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast. At\n___ o'clock 5 cm from the nipple there is a 0.6 x 0.3 x 0.5 cm oval\ncircumscribed hypoechoic mass with internal vascularity which corresponds to\nthe mass on mammography.", + "output": "Indeterminate mass in the right breast for which ultrasound-guided biopsy is\nrecommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the right breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 10:02 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "On the right breast at ___ o'clock 5 cm from the nipple, there is a 0.6 x 0.3\nx 0.6 cm oval circumscribed hypoechoic mass corresponding to the finding seen\non mammogram from ___.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.clinicians The procedure was supervised by ___.\n___, M.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 8\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "On the right breast at ___ o'clock 5 cm from the nipple, there is a 0.6 x 0.3\nx 0.6 cm oval circumscribed hypoechoic mass corresponding to the finding seen\non mammogram from ___.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.clinicians The procedure was supervised by ___.\n___, M.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 8\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.1 L of bloody fluid were removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, yielding 3.1 L of bloody ascitic fluid. Fluid samples were\nsubmitted to the laboratory for cell count, differential, culture, and\ncytology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe homogeneous atherosclerotic plaque.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 93 cm/s / 20 cm/s\nCCA Distal: 72 cm/s / 17 cm/s\nICA ___: 57 cm/s / 26 cm/s\nICA Mid: 548 cm/s / 339 cm/s though the waveform quality is relatively\npoor thus these measurements may be somewhat inaccurate.\nICA Distal: 111 cm/s / 24 cm/s\nECA: 117\nVertebral: 50 cm/s\n\nICA/CCA Ratio: 7.7\n\nThe right CCA spectral waveform is normal.\nThe right ICA spectral waveform is normal\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 118 cm/s / 20 cm/s\nCCA Distal: ___\nICA ___: 104 cm/s / 29 cm/s\nICA Mid: 84 cm/s / 35 cm/s\nICA Distal: 73 cm/s / 24 cm/s\nECA: 67 cm/s\nVertebral: 33 cm/s\n\nICA/CCA Ratio: 1.0\n\nThe left CCA spectral waveform is normal.\nThe left ICA spectral waveform is normal.\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Likely 80-99% stenosis of the right internal carotid artery, though the\nwaveforms are of limited quality thus the measurements above may be slightly\ninaccurate.\n< 40% stenosis of the left internal carotid artery.\n\nNOTIFICATION: Results were discussed with Dr. ___ on ___ at 1155." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 67, 60, and 53 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 70, 62, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 60 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral ___ ICA stenosis. Antegrade vertebral flow." + }, + { + "input": "Targeted ultrasound the left upper outer quadrant at the patient's area of\nclinical concern at 1 o'clock 12 cm from the nipple demonstrates a normal 1.4\ncm lymph node with normal cortical thickness. Scanning of the left axilla\ndemonstrates multiple normal appearing lymph nodes. No specific abnormality\nis seen at the 3 o'clock location.", + "output": "No specific evidence of malignancy. The patient's palpable finding is a\nnormal appearing lymph node.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Right common femoral artery: Arteriotomy is well above the bifurcation. There\nis good distal runoff. There is no evidence for dissection. Vessel caliber\nappropriate for closure device.\n\nRight internal carotid artery: Angiography of the right internal carotid\nartery reveals a M1 occlusion. After several passes with a stent retriever\ncomplete revascularization of the middle cerebral artery was achieved.\n\nRight middle cerebral artery: Distal filling of the branches of the middle\ncerebral artery confirming placement of the microcatheter passes the point of\nocclusion.", + "output": "1. Right M1 occlusion status post mechanical thrombectomy with complete\nrevascularization (TICI 3)\n\nI, Dr. ___, was personally present and participated in the entirety of the\nprocedure; I have reviewed the above images and agree with the findings as\nstated above." + }, + { + "input": "Targeted ultrasound of the medial right breast demonstrates normal\nfibroglandular tissues. No mass identified, similar to ultrasound from ___.", + "output": "No ultrasound correlate for the mass seen on recent screening mammogram from\n___ in retrospect, area on mammogram has not changed significantly\nsince ___ consistent benign process.\n\nRECOMMENDATION(S): Patient should return to annual screening mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Targeted ultrasound of the right neck demonstrates a predominantly hypoechoic\ncollection, with a more central hypoechoic component, measuring approximately\n2.0 x 1.3 x 2.4 cm, previously approximately 2.6 x 1.4 x 2.5 cm. This\ncollection was targeted for ultrasound-guided aspiration.", + "output": "Successful US-guided aspiration of a right neck collection, as described\nabove. Samples were sent for microbiology evaluation and triglycerides as per\nrequest by the team. The patient with stood the procedure well." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nPreviously seen asymmetry in the central right breast persists on some spot\ncompression views and appears to localize to the upper breast on the rolled\nimages, however this asymmetry appears to correspond to normal breast\nsuperimposed tissue on 3D digital breast tomosynthesis images. There are no\nsuspicious calcifications, spiculated mass or area of architectural\ndistortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper central right breast was\nperformed which was without any discrete suspicious solid or cystic masses.", + "output": "There is a probably benign asymmetry in the central upper right breast without\nsonographic correlate.\n\nRECOMMENDATION(S): Six-month follow-up with diagnostic mammogram of the right\nbreast is recommended to document stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There is an approximately 1.5 cm focal\nasymmetry in the central upper right breast, slightly denser compared with\nprior mammogram.\nThere is no architectural distortion or suspicious grouped\nmicrocalcifications. There are no new suspicious abnormalities in left\nbreast.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the upper central right breast was performed. At 11:30\no'clock position 6 cm from the nipple there is a 12 x 7 x 13 mm hypoechoic\noval mass with no internal vascularity. No other cystic or solid masses are\nseen.", + "output": "There is an indeterminate hypoechoic mass 11:30 position in the right breast,\nwhich likely corresponds to a focal asymmetry, which slightly more prominent.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast\nis recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She was given information to schedule her biopsy appointment. The\nimpression and recommendation above was entered by Dr. ___ on\n___ at 17:47 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There is an approximately 1.5 cm focal\nasymmetry in the central upper right breast, slightly denser compared with\nprior mammogram.\nThere is no architectural distortion or suspicious grouped\nmicrocalcifications. There are no new suspicious abnormalities in left\nbreast.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the upper central right breast was performed. At 11:30\no'clock position 6 cm from the nipple there is a 12 x 7 x 13 mm hypoechoic\noval mass with no internal vascularity. No other cystic or solid masses are\nseen.", + "output": "There is an indeterminate hypoechoic mass 11:30 position in the right breast,\nwhich likely corresponds to a focal asymmetry, which slightly more prominent.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast\nis recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She was given information to schedule her biopsy appointment. The\nimpression and recommendation above was entered by Dr. ___ on\n___ at 17:47 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the right breast at 11:30, 6 cm from the nipple there is an ovoid\nhypoechoic mass without significant posterior shadowing that measures 1.5 x\n0.9 cm and appears grossly stable compared to prior exam.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, MD ___, M.D.. The procedure was\nsupervised by ___, M.D. (attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 10 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast at 11:30, 6 cm from the nipple there is an ovoid\nhypoechoic mass without significant posterior shadowing that measures 1.5 x\n0.9 cm and appears grossly stable compared to prior exam.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, MD ___, M.D.. The procedure was\nsupervised by ___, M.D. (attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 10 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe previously described of mass within the upper outer right breast and 2\nasymmetries persist with additional imaging.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. At the 10 o'clock\nposition of the right breast approximately 8 cm from the nipple, there is a\n1.4 x 0.8 x 2 cm simple cyst corresponding to the screen detected mass. \nAdditional cysts are visualized adjacent to the dominant cyst and at the 9 to\n10:00 position of the right breast approximately 8 cm from the nipple, 2 of\nwhich are felt to correspond to the screen detected asymmetries. No\nsuspicious abnormality is identified.", + "output": "Simple cysts corresponding to the screening mammographic abnormalities of\nconcern. No suspicious abnormality.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Bilateral prominent axillary lymph nodes are seen with cortical thickness\nmeasuring up to 0.6 cm. Given the bilaterality of this finding, an underlying\nsystemic process such as rheumatoid arthritis is the likely cause.", + "output": "Bilateral prominent axillary lymph nodes suggest an underlying systemic\nprocess. Given the patient's known history of rheumatoid arthritis, this is\nthe likely cause.\n\nRECOMMENDATION(S): Clinical followup is recommended. If confirmation of\nbenignity is desired, then histologic sampling may be performed as clinically\nindicated.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 101, 99, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.\nThe external carotid artery has peak systolic velocity of 110 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 102, 93, and 90 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is no evidence of significant stenosis in the internal carotid arteries\nbilaterally." + }, + { + "input": "The uterus is normal in size and echogenicity measuring 4.3 x 2.7 x 7.9 cm. \nThe endometrium is normal in appearance measuring 5 mm in thickness.\n\nThe left ovary is small and unremarkable. The right ovary shows normal\narchitecture with 2 follicular cysts, which correspond to the low density on\nCT. Vascularity is normal on color-flow Doppler. There are no findings to\nsuggest ___ abscess.", + "output": "Normal transabdominal pelvic ultrasound." + }, + { + "input": "Given lack of hyperechoic walls which we would expect with a graft, this is\nlikely an AV fistula. The left forearm AV fistula is seen with normal\ngrayscale and color flow throughout the fistula, without evidence of\nthrombosis. Given lack of hyperechoic walls which we would expect with a\ngraft, this is likely an AV fistula.", + "output": "Given lack of hyperechoic walls which we would expect with a graft, this is\nlikely an AV fistula. The left forearm AV fistula is seen with normal flow\nthroughout the fistula, without evidence of thrombosis." + }, + { + "input": "Targeted ultrasound of the right breast was performed.\n\nPre aspiration images again demonstrate a multiloculated, heterogeneous,\npredominantly hypoechoic complex fluid collection in the right upper outer\nquadrant of the breast. 3 discrete fluid collections are identified at ___\no'clock 12 cm from the nipple and 10 o'clock 6 cm from the nipple which were\ntargeted for drainage.\n\nAlso, evaluation was performed in the retroareolar area at area of prior fluid\ncollection. In the right breast at 9 o'clock approximately 2 cm from the\nnipple, re-demonstrated is a heterogeneous fluid collection measuring\napproximately 1.3 x 0.7 cm, significantly decreased in size compared to ___. This was not targeted for aspiration.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___. ___, MD ___, N.P. and ___, M.D.\n(Attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and 1% lidocaine for local\nanesthesia, attention was first directed to the more lateral fluid collection\nlocated at 10 o'clock approximately 12 cm from the nipple. A a 16 gauge\nneedle was placed into the collection and approximately 6 cc of thin, purulent\nbrown fluid was obtained. The fluid was sent to microbiology.\n\nUsing ultrasound guidance, aseptic technique and 1% lidocaine for local\nanesthesia, attention was then directed to the more superficial of the medial\ncollections located at 10 o'clock approximately 6 cm from the nipple. A 16\ngauge needle was then placed into collection and a small amount of thin,\npurulent brown fluid was aspirated. The 16 gauge needle was then redirected\ninto the deeper of the medial collections located at 10 o'clock approximately\n6 cm from the nipple and similar thin, purulent brown fluid was obtained. A\ntotal of 3 cc of fluid was obtained from the medial collections. This fluid\nwas discarded.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to microbiology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast abscess.\nStandard post care instructions were provided to the patient.", + "output": "Technically successful US-guided aspiration of the right breast abscesses.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation.\n\nRECOMMENDATION(S): Age and risk appropriate screening." + }, + { + "input": "Re-demonstrated are residual heterogeneous predominantly hypoechoic complex\nfluid collections in the right upper outer quadrant of the breast- the largest\nmeasuring 2.1 x 2.1 x 1.2 cm at the 9 o'clock position 12 cm from the nipple,\npreviously 3.2 x 1.9 x 3.1 cm.\nThe collection at the ___ o'clock position 9 cm from the nipple currently\nmeasures 1.3 x 1.3 x 0.7, previously 1.8 x 1.4 x 1.7 cm.\nThe hypoechoic collection at the 9 o'clock position 6 cm from the nipple\ncurrently measures 0.6 x 0.6 x 1.3 cm, previously 2.0 x 2.4 x 1.1 cm.\nThe hypoechoic fluid collection, which was not drained on prior exam, at the 9\no'clock position 2 cm from the nipple currently measures 1.0 x 0.5 x 1.0 cm,\npreviously 1.3 x 0.7 x 0.7 cm.", + "output": "Residual pockets of fluid in the right breast, the largest measuring up to 2.1\ncm.\n\nRECOMMENDATION(S): Final disposition of these findings should be based on\nclinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight: There is generalized increased tissue density seen in the right\nretroareolar region extending to the upper-outer quadrant (best on\ntomosynthesis views) measuring 4.5 x 3.8 x 4.7 cm (TRV, AP, SAG), without an\nunderlying mass. There is heterogeneously dense parenchyma in the upper outer\nquadrant at the ultrasound finding at 10 o'clock 7 cm from the nipple without\nunderlying mass on mammography.\n\nProminent right axillary lymph node is seen. There are no suspicious\ncalcifications.\n\nLeft: There is a 7 x 5 mm isoechoic mass in the medial upper left breast, seen\nto be a cyst on same date ultrasound. Otherwise, the left breast is without\nsuspicious dominant mass, architectural distortion or suspicious grouped\ncalcification.\n\nBILATERAL BREAST ULTRASOUND:\nRight: Targeted ultrasound of the right upper outer quadrant at 10 o'clock 6-7\ncm from the nipple demonstrates a 2.9 x 1.7 x 2.1 cm hypoechoic heterogeneous\nmass with internal septations and internal heterogeneity with surrounding\nprominent vascularity and through transmission. This may represent an abscess\ncollection or a solid mass.\n\nScanning of the right retroareolar region at 9 o'clock 0-2 cm from the nipple\ndemonstrates a heterogeneous fluid collection extending from the nipple into\nthe lateral parenchyma with prominent vascularity and hyperechoic adjacent\ntissue measuring 2.5 x 1.0 x 2.1 cm. This area is concerning for an abscess.\n\nLeft: Scanning of the left medial upper breast at 10 o'clock 4 cm from the\nnipple demonstrates a 7 x 6 x 4 mm simple cyst which corresponds to the\nfinding seen on mammography.", + "output": "Right: 2.9 x 1.7 x 2.0 cm heterogeneous hypoechoic mass right breast 10\no'clock 6-7 cm from the nipple possibly representing an abscess. Of note,\nthis is occult on mammography. Further evaluation with aspiration/drainage is\nrecommended. If the lesion is solid, consideration should be given to\nultrasound-guided core biopsy.\n\n2.5 x 1.0 x 2.1 cm heterogeneous fluid collection in the right retroareolar\nregion at 9 o'clock 0-2 cm from the nipple concerning for an abscess. \nAspiration/drainage is recommended.\n\nLeft: No specific evidence of malignancy in the left breast.\n\nRECOMMENDATION(S): 2 areas of concern for which aspiration/drainage is\nrecommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given an appointment later same day at ___\nBreast Imaging ___ 12:45 for aspirations.\nPreliminary email sent to Dr. ___, as the patient will likely need\nantibiotic coverage.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Again seen in the right breast at 10 o'clock 6 cm from the nipple is an\nanechoic fluid collection with internal debris. At in the right breast at 9\no'clock 2 cm from the nipple is an anechoic fluid collection adjacent to the\nnipple. A third anechoic fluid collection was identified in the right breast\n___ o'clock 12 cm from the nipple measuring 2.4 x 1.5 x 2.4 cm. All 3 of\nthese collections were targeted for aspiration.\n\nUltrasound of the right axilla shows normal appearing lymph nodes.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P. and ___, M.D. (Attending).\n\nDescription:\nAttention was first directed to the fluid collection adjacent to the nipple in\nthe right breast at 9 o'clock 2 cm from the nipple. Using ultrasound\nguidance, aseptic technique and 1% lidocaine for local anesthesia, a 16 gauge\nneedle was placed into the lesion and 2 cc of bright green pus was aspirated. \nThis aspirated to resolution. The pus from this aspiration was sent to\nmicrobiology for examination.\n\nAttention was then directed to the fluid collection in the right breast at 10\no'clock 6 cm from the nipple. Using standard aseptic technique and 1%\nlidocaine for local anesthesia a 16 gauge needle was advanced into the cavity.\n2 cc of bright green pus was aspirated. This aspirated to near resolution.\n\nAttention was then directed to the fluid collection in the right breast ___\no'clock 12 cm from the nipple. Using standard aseptic technique and 1%\nlidocaine for local anesthesia a 16 gauge needle was advanced into the cavity.\n2 cc of bright green pus was aspirated. There was residual pus noted post\naspiration.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to microbiology\nAnesthesia: ___ cc 1% lidocaine at each location\nComplications: No immediate complications.\nPost procedure diagnosis: 3 aspirated right breast abscesses.", + "output": "Technically successful US-guided aspiration of 3 right breast abscesses. \nStandard post care instructions were provided to the patient.\n\nRECOMMENDATION(S): The patient was sent to the fifth floor ___ breast\ncare center to see ___ NP." + }, + { + "input": "Re-demonstrated is a multiloculated, heterogeneous, predominantly hypoechoic\ncomplex fluid collection in the right upper outer quadrant of the breast. The\ncollection located at 10 o'clock approximately 7 cm from the nipple measures\n2.4 x 1.1 x 2.0 cm and demonstrates a central focus of echogenic material.\nImmediately deep and lateral to, although separate from, this collection is a\nsecond heterogeneous collection measuring 1.8 x 1.4 x 1.7 cm. A third\ncollection located at ___ o'clock approximately 12 cm from the nipple\nmeasures 3.1 x 2.0 x 3.1 cm and contains a central focus of echogenic\nmaterial. The fluid collections do not appear to communicate. The surrounding\nsoft tissues are echogenic with mild hyperemia, in keeping with inflammation\nand edema.", + "output": "Interval reaccumulation of right breast abscess.\n\nRECOMMENDATION(S): Ultrasound-guided abscess drainage.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. This was performed immediately after this exam.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the right axilla demonstrates a 2.3 x 1.8 x 1.4 cm\nirregular mass in the right lower lateral axilla consistent with adenopathy.\nThis appears slightly smaller from the prior imaging. The second lesion\nappears similar measuring 1.2 cm x 1.1 cm x 1 cm.\n\nIn the right breast at 10 o'clock 4 cm from the nipple is a large irregular\nhypoechoic mass which measures 4.6 x 3 x 2.5 cm with dominant vascularity.\nThis was not previously documented. There is heterogeneity to the mass in the\nretro areolar region the size of which is not able to be documented by\nultrasound. Extensive skin thickening is noted.\n\nThe following incidental smaller lesions were documented:\nThe right breast lesion at 12 o'clock 8 cm from the nipple measures 0.8 x 0.5\nx 0.4 cm and appears smaller compared to the prior study.\nThe right breast lesion at 1 o'clock 8 cm from the nipple measures 1.3 x 0.9 x\n1.3 cm. This is slightly larger than the prior study.\nThe right breast lesion at 10 o'clock 7 cm from the nipple demonstrates 1 x\n0.9 x 0.9 cm and appear similar to the prior study.", + "output": "Overall interval worsening when compared with the prior images.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThere are expected post treatment changes in the left breast. There is a clip\nin the upper outer left breast from prior benign percutaneous core biopsy. \nThere are bilateral benign calcifications and vascular calcifications. There\nis no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications seen in either breast.\n\nTargeted ultrasound of the left breast was performed with attention to the\nreported area of clinical concern. The patient's physician felt ___ palpable\nabnormality at 3 o'clock at the periphery of the breast. To my clinical exam,\nthere is some nodularity at 2 o'clock, at the periphery of the breast. The\nentire left lateral breast was scanned. No discrete cystic or solid mass is\nseen.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening. Final disposition of\nany clinical findings should be based on clinical grounds. The patient is\nscheduled to see ___, NP, later today.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThere are expected post treatment changes in the left breast. There is a clip\nin the upper outer left breast from prior benign percutaneous core biopsy. \nThere are bilateral benign calcifications and vascular calcifications. There\nis no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications seen in either breast.\n\nTargeted ultrasound of the left breast was performed with attention to the\nreported area of clinical concern. The patient's physician felt ___ palpable\nabnormality at 3 o'clock at the periphery of the breast. To my clinical exam,\nthere is some nodularity at 2 o'clock, at the periphery of the breast. The\nentire left lateral breast was scanned. No discrete cystic or solid mass is\nseen.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening. Final disposition of\nany clinical findings should be based on clinical grounds. The patient is\nscheduled to see ___, NP, later today.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is moderate to large ascites seen throughout the abdomen, amenable to\nparacentesis.", + "output": "There is moderate to large ascites seen throughout the abdomen, amenable to\nparacentesis." + }, + { + "input": "In the area of the dominant palpable concern in the ___ o'clock position 7 cm\nfrom nipple there is a large hypoechoic irregular vascular mass measuring a\n4.9 x 3.0 x 4.4 cm. The mass extends to the skin and appears to involve the\ndeeper dermal levels. There is edema of the adjacent skin with skin thickness\nof 6 mm. In the area of skin retraction in the ___ o'clock position 11 cm\nfrom the nipple there is a second large hypoechoic irregular mass measuring\n4.5 x 4.5 x 3.8 cm. Ultrasound of the lower right axilla reveals at least 2\nsuspicious enlarged lymph nodes measuring 2.6 and 2 cm.", + "output": "At least 2 highly suspicious masses in the upper-outer right breast,\nsuspicious for breast carcinoma. Right axillary lymphadenopathy suspicious\nfor axillary metastatic disease.\n\nRECOMMENDATION(S): Tissue diagnosis is recommended. These masses are\namenable to ultrasound-guided core needle biopsy.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study and also with ___, NP. Dr.\n___ was also notified via email.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2370 mL of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential,\nculture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. Approximately 2.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate to\nlarge amount of ascites. A suitable target in the deepest pocket in the right\nlower quadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of serosanguineous fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, culture and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis.\n2. Approximately 3 L of fluid were removed." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 82.1 cm/s / 11.7 cm/s\nCCA Distal: 75 cm/s / 11.1 cm/s\nICA ___: 53.8 cm/s / 11.4 cm/s\nICA Mid: 60.1 cm/s / 14.1 cm/s\nICA Distal: 63.2 cm/s / 16.1 cm/s\nECA: 47.5 cm/s\nVertebral: 40.5 cm/s\n\nICA/CCA Ratio: 0.84\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 59.3 cm/s / 11.8 cm/s\nCCA Distal: 62.1 cm/s / 10.2 cm/s\nICA ___: 54.2 cm/s / 9.43 cm/s\nICA Mid: 102 cm/s / 32.2 cm/s\nICA Distal: 80.8 cm/s / 24.9 cm/s\nECA: 91.9 cm/s\nVertebral: 61.3 Cm/s\n\n\nICA/CCA Ratio: 1.64\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. \nMultiple other liver lesions were also seen, better assessed on prior CT. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with approximately 15 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 2 18-gauge core biopsy passes were made. \nThe sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Sedation was provided by administering divided doses of 75 mcg\nfentanyl throughout the total intra-service time of 35 minutes during which\npatient's hemodynamic parameters were continuously monitored by an independent\ntrained radiology nurse.", + "output": "Technically successful 18-gauge targeted liver biopsy x 2, with specimen sent\nto pathology.\n\nNOTIFICATION: The patient is currently on heparin for treatment of an acute\npulmonary embolism. The heparin was held prior to the procedure. Heparin\nwill be resumed 2 hours following the end of the procedure. This was\ndiscussed and agreed upon by ___, M.D. on the telephone on ___ at\n4:25 pm." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Ultrasound was performed for further evaluation of\nbilateral breast pain.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast from\n___ o'clock 12 cm from the nipple and of the left breast at 3 o'clock 12 cm\nfrom the nipple in the area of pain as indicated by the patient. No solid or\ncystic mass was identified.", + "output": "No mammographic or sonographic findings to explain the patient's bilateral\nbreast pain. Clinical follow-up is recommended. No specific evidence of\nmalignancy.\n\nRECOMMENDATION(S): Clinical followup for bilateral breast pain.\nAnnual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 89, 88, and 99 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 98 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 83, 93, and 102 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 41 cm/sec.\nThe ICA/CCA ratio is 1.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of significant stenosis in internal carotid arteries bilaterally." + }, + { + "input": "BILATERAL BREAST MAMMOGRAM:\nTissue density: There are scattered areas of fibroglandular density.\nA wire marker has been placed along the central outer right breast denoting\nsite of prior surgery. Underlying architectural distortion and associated\nsurgical clips are related to posttreatment change. Additional surgical clips\nare noted in the right axilla related to axillary lymph node dissection. \nThere is increased right breast skin thickening. No dominant mass,\nunexplained architectural distortion, or suspicious group of\nmicrocalcifications is identified.\n\nRIGHT BREAST ULTRASOUND:\nTargeted ultrasound of the 2 to 10 o'clock position right breast 0-10 cm from\nthe nipple demonstrates significant skin thickening measuring up to 1.0 cm. \nNo suspicious solid or cystic mass is appreciated.\nTargeted ultrasound of the right axilla is without abnormal lymph nodes.", + "output": "Expected posttreatment changes of the right breast with significant skin\nthickening. No specific evidence for malignancy.\n\nRECOMMENDATION: Recommend annual diagnostic mammography in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL BREAST MAMMOGRAM:\nTissue density: There are scattered areas of fibroglandular density.\nA wire marker has been placed along the central outer right breast denoting\nsite of prior surgery. Underlying architectural distortion and associated\nsurgical clips are related to posttreatment change. Additional surgical clips\nare noted in the right axilla related to axillary lymph node dissection. \nThere is increased right breast skin thickening. No dominant mass,\nunexplained architectural distortion, or suspicious group of\nmicrocalcifications is identified.\n\nRIGHT BREAST ULTRASOUND:\nTargeted ultrasound of the 2 to 10 o'clock position right breast 0-10 cm from\nthe nipple demonstrates significant skin thickening measuring up to 1.0 cm. \nNo suspicious solid or cystic mass is appreciated.\nTargeted ultrasound of the right axilla is without abnormal lymph nodes.", + "output": "Expected posttreatment changes of the right breast with significant skin\nthickening. No specific evidence for malignancy.\n\nRECOMMENDATION: Recommend annual diagnostic mammography in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "The aorta measures 2.4 cm in the proximal portion, 2.0 cm in mid portion and\n1.7 cm in the distal abdominal aorta. There is mild calcified atherosclerotic\nplaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.1 cm and the left common iliac artery\nmeasures 1.1 cm.\n\nThe right kidney measures 12.0 cm cm and the left kidney measures 12.5 cm cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "RIGHT:\nThere is mild atherosclerotic plaque within the right carotid bulb.\nThe peak systolic velocity in the right common carotid artery is 73.3 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 53.9, 75.0, and 69.2 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25.2 cm/sec.\nThe ICA/CCA ratio is 1.02.\nThe external carotid artery has peak systolic velocity of 53.9 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThere is mild intimal thickening along the distal left common carotid artery\nas well as mild atherosclerotic plaque within the carotid bulb.\nThe peak systolic velocity in the left common carotid artery is 75.8 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 34.5, 54.8, and 52.6 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 16.3 cm/sec.\nThe ICA/CCA ratio is 0.72.\nThe external carotid artery has peak systolic velocity of 67.6 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. No hemodynamically significant stenosis.\n2. Mild atherosclerotic plaque in both carotid bulbs." + }, + { + "input": "RIGHT LOWER EXTREMITY: There is no evidence of DVT in the right lower\nextremity. No evidence of reflux was identified in the right greater\nsaphenous vein. Mild reflux was identified in the right popliteal vein and\nsignificant reflux was identified in the right lesser saphenous vein. The\nreflux in the right lesser saphenous vein ranged from 2.2 to 5.4 seconds.\n\nThe lesser saphenous veins ranges from 0.42-0.6 cm in caliber in the calf\nartery depth of approximately 0.6-0.7 cm. The greater saphenous veins ranges\nfrom 0.38- 0.83 cm of caliber in the thigh at the depth that ranges from\n0.9-1.6 cm. The greater saphenous veins ranges from 0.41 0.66 cm in the calf\nat a depth of 0.2-0.4 cm.\n\nLEFT FLOWER EXTREMITY: There is no evidence of DVT in the left lower\nextremity. There is significant venous reflux in the left greater saphenous\nvein from the ankle to the proximal thigh ranging from 2.2 - 6.0 seconds. No\nreflux was identified in the left lesser saphenous vein.", + "output": "1. No evidence of DVT in either lower extremity.\n\n2. Reflux in the right lesser saphenous vein and in the left greater\nsaphenous vein.\n\n3. For detail description of caliber and depth of the mapped greater\nsaphenous at right lesser saphenous veins please refer to the technologist\nreport in PACs." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 150 cc of serosanguinous fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 150 cc of fluid were removed, sent for the requested analyses." + }, + { + "input": "The right kidney measures 10.9 cm in length. Color Doppler flow to the right\nkidney is demonstrated. Left kidney measures at least 6.3 cm in length but\nwas more difficult to visualize sonographically left due to limited acoustic\nwindows and substantial motion artifact. In particular, was not possible to\nperform even a limited Doppler examination. A simple cysts could be\nidentified, however, along the lower pole of the left kidney, measuring up to\n2.1 x 1.7 x 2.5 cm. Imaging was also adequate demonstrate that no\nhydronephrosis is present on the left. Bladder was empty with a Foley\ncatheter demonstrated in situ.", + "output": "No hydronephrosis on either side. It was possible to show Doppler flow to the\nright kidney but study was too limited to assess flow to the left kidney." + }, + { + "input": "The aorta measures 2.6 cm in the proximal portion, 2.3 cm in mid portion and\n1.8 cm in the distal abdominal aorta. There are mild calcified\natherosclerotic plaques.\n\nWall-to-wall color flow is seen within aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.1 cm and the left common iliac artery\nmeasures 1.3 cm.\n\nThe right kidney measures 11.3 cm and the left kidney measures 11.0 cm. No\nhydronephrosis is seen in either kidney. There is an exophytic cortical cyst\nin the right kidney which measures 1.3 x 0.9 cm. A 5 mm nonobstructing stone\nis seen at the lower pole of the right kidney and a 4 mm nonobstructing stone\nis seen at the upper pole of the right kidney. A nonobstructing stone\nmeasuring 1.3 cm is seen at the lower pole of the left kidney and an 8 mm\nnonobstructing stone is seen at the upper pole of the left kidney.\nAdditionally a 3 mm crystal in the midportion of the left kidney is likely\nwithin a calyceal diverticulum. An exophytic simple cyst is seen at the lower\npole of the left kidney measuring 1.8 x 1.4 cm.", + "output": "1. Atherosclerotic aorta. No aneurysm is visualized.\n2. Bilateral nonobstructing stones and small simple bilateral cysts are noted\nin the kidneys." + }, + { + "input": "The examination was significantly limited due to patient's agitation. Normal\ncolor flow was identified within the right and left subclavian veins, and also\nwithin the right internal jugular vein. No thrombus seen within either the\nright subclavian vein or right internal jugular vein. The right internal\njugular vein does not completely compress on the provided image, although\nnormal color flow is seen and no echogenic thrombus is demonstrated, and\nincomplete compression could possibly relate to difficulty performing the\ncompression maneuver. The remainder of the examination could not be performed\ndue to the patient's agitation.", + "output": "Significantly limited examination due patient inability to\ntolerate the exam. No definite evidence of DVT in right internal jugular or\nsubclavian veins on limited images provided." + }, + { + "input": "Partially visualized is the left breast implant. From 3 o'clock to 9 o'clock,\napproximately 5 cm from the nipple, there is a hypoechoic fluid collection\nmeasuring approximately 4.0 x 1.4 x 7.7 cm. There is no significant\nsurrounding hyperemia.", + "output": "Hypoechoic collection approximately 5 cm from the nipple along the inferior\nleft breast measuring approximately 4.0 x 1.4 x 7.7 cm likely represents a\npostoperative seroma. However, superimposed infection cannot be excluded. If\ncontinued clinical concern, follow-up in the breast clinic." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 3 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(microbiology, hematology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 6 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(microbiology, hematology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 6 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is no dominant mass, asymmetry, architectural distortion or suspicious\ngrouped calcifications in the right breast. The area of prior 8 mm rounded\nasymmetry in the upper central breast is not present on the current images,\nconsistent with overlapping glandular tissue.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right upper central breast was\nperformed from 10 o'clock through 2 o'clock demonstrating extremely dense\nparenchyma without underlying suspicious solid or cystic mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual mammography. Consideration should be given to\nsupplemental screening due to the patient's tissue density. We discussed the\npossibility of participating in the now should all research project involving\nfast/abbreviated breast MRI.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "In the right breast at 7 o'clock 9 and 10 cm from the nipple, underlying\nsurgical scar, there is a circumscribed anechoic mass with no internal\nvascularity and with increased through transmission, consistent with\npostoperative seroma measuring 2 x 5 x 2 cm. There is no internal\nvascularity. This is stable since ___ study. There are no suspicious cystic\nor solid masses in the vicinity.", + "output": "Postoperative seroma in the area of palpable concern in the right lower\nbreast. Clinical followup is recommended.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound was performed of the right breast at the 10 o'clock\nposition, 5-7 cm from the nipple. There is a well-circumscribed anti parallel\nhypoechoic mass that measures approximately 1.5 x 1.9 x 1.5 cm. The internal\ncontents a layering fluid level without evidence of vascularity. The right\nnipple is unremarkable.", + "output": "1.9 cm hematoma at the 10 o'clock position, 5-7 cm from the nipple. \nUnremarkable right nipple.\n\nRECOMMENDATION(S): Follow-up ultrasound of the right breast is recommended to\ndocument resolution of hematoma." + }, + { + "input": "BILATERAL BREAST MAMMOGRAM:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n0.8 cm well-circumscribed oval-shaped mass in the upper outer left breast is\nunchanged dating back to ___ and consistent with an intramammary lymph node. \nNo spiculated mass, unexplained architectural distortion, or suspicious group\nof microcalcification is identified in either breast.\n\nRIGHT BREAST ULTRASOUND:\nTargeted ultrasound of the right breast 8 to 10 o'clock position 10-13 cm from\nthe nipple demonstrates no abnormal sonographic correlate in the area of pain\nas indicated by the patient. No suspicious solid or cystic mass is\nidentified.", + "output": "1. No abnormal sonographic correlate to the area of pain in the right breast\nas indicated by the patient.\n2. No specific evidence for malignancy.\n\nRECOMMENDATION: Annual mammographic surveillance is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild calcified atherosclerotic plaque within\nthe right internal carotid artery and mild soft plaque within the common\ncarotid artery.\nThe peak systolic velocity in the right common carotid artery is 35 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 42, 43, and 47 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 44 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild calcified atherosclerotic plaque\ngreatest within the carotid bulb and proximal ICA.\nThe peak systolic velocity in the left common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 26, 43, and 51 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 71 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild mixed plaque atherosclerosis of the bilateral carotid vasculature which\nresults in less than 40% stenosis bilaterally." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 9\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Successful ultrasound-guided drainage/drain placement into a superficial\nabdominal wall collection yielding 15 cc of serosanguineous fluid. The complex\nappearance of this collection on ultrasound and small amount of drainable\nfluid obtained suggests this may be a hematoma.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection, which has the US appearance of a hematoma given the very small\namount of serosanguinous fluid that could be aspirated. Samples were sent for\nmicrobiology evaluation." + }, + { + "input": "Scans were performed over the area of pain and induration in the midline\nabdominal wall demonstrating a hypoechoic, essentially solid and avascular a\nfocal lesion measuring 5.2 by 3.7 x 7.8 cm. Within this focal region portion\nof the drainage catheter is visualized. There are no pockets of localized\nfluid seen. The size of the focal abnormality is slightly smaller than pre D\na drainage measurements on ___ which were 5.4 x 4.8 x 9.2 cm.", + "output": "The drainage catheter is centrally positioned within what appears to be a\nresidual essentially solid hematoma with no pockets of drainable fluid\nidentified." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated a\nmoderate pleural fluid. A suitable target in the deepest pocket in the right\nposterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine buffered with\nsodium bicarbonate was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 1.3 L of serosanguineous fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nSamples were sent off for hematology, biochemistry and microbiology analysis.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Successful ultrasound-guided right therapeutic and diagnostic thoracentesis" + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated\nmoderate pleural fluid. A suitable target in the deepest pocket in the right\nposterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine buffered with\nsodium bicarbonate was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 800 mL of dark red, sanguinous fluid was\nremoved. Estimated blood loss was minimal.\n\nNear the completion of the procedure, the patient complained of substernal\nchest pain and shortness of breath. Following the termination of procedure,\nthe patient was evaluated in placed on 5L O2 via nasal cannula. Vital signs\nwere stable, physical exam was normal, and a point of care EKG was\nunremarkable. The patient was subsequently taken for a departmental chest\nradiograph which demonstrated a tiny, apical right pneumothorax without\nevidence of tension physiology. Subsequently, the patient was returned to the\nradiology care unit and reported feeling back to baseline.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Successful right thoracentesis resulting in the removal of 800 mL of\nsanguinous fluid. Immediate postprocedural chest pain and shortness of breath\nwere evaluated and treated, as above.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to Dr. ___ telephone at\n15:46 on ___, 2 min after interpretation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nLimited grayscale ultrasound imaging of the right hemithorax demonstrated a\nsmall to moderate pleural fluid. A suitable target in the deepest pocket in\nthe right posterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nPARACENTESIS:\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia. A 5 ___ catheter was advanced into the largest fluid\npocket in the right lower quadrant and 5 L of slightly cloudy, straw colored\nfluid was removed. The patient tolerated the procedure well without immediate\ncomplication. Estimated blood loss was minimal.\n\nTHORACENTESIS:\nAttention was then turned to the right hemithorax. Under ultrasound guidance,\nan entrance site was selected and the skin was prepped and draped in the usual\nsterile fashion. 1% lidocaine was instilled for local anesthesia. A 5 ___\ncatheter was advanced into the largest fluid pocket in the right posterior mid\nscapular line and 500 mL of dark red serosanguineous fluid was removed. The\npatient tolerated the procedure well without immediate complication. The\npatient's oxygen saturation after the procedure was 95% on room air. Estimated\nblood loss was minimal.\n\nDr. ___, the attending radiologist, was present throughout the\ncritical portions of the procedure.", + "output": "1. Technically successful ultrasound-guided therapeutic paracentesis of 5 L\nascitic fluid.\n2. Technically successful ultrasound-guided therapeutic thoracentesis of 500\nmL dark red serosanguinous pleural fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated a\nlarge amount of pleural fluid. A suitable target in the deepest pocket in the\nright posterior lower chest lateral to the mid scapular line at the site of\nthe prior recent thoracentesis was chosen.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained. A pre-procedure\ntime-out was performed discussing the planned procedure, confirming the\npatient's identity with 3 identifiers, and reviewing a checklist per ___\nprotocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 6 cc of 1% lidocaine was\ninstilled for local anesthesia.\n\nA 5 ___ ___ catheter was advanced into the largest fluid pocket in the\nright posterior lower chest lateral to the mid scapular line at the site of\nthe prior recent thoracentesis and 1.7 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate post-procedural\ncomplication. Estimated blood loss was minimal.\n\nDr. ___, the attending radiologist, was present throughout the\ncritical portions of the procedure.", + "output": "Technically successful ultrasound-guided thoracentesis of right pleural\neffusion. No immediate post-procedure complications." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 111 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 181, 159, and 67 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 50 cm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 237 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 70, 58, and 43 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 123 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "60-69% stenosis of the right internal carotid artery.\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe asymmetry though re-demonstrated on the central breast on spot compression\nviews, and appears isodense to the breast parenchyma and on tomosynthesis\ndemonstrates summation of breast parenchyma likely accounting for the\nasymmetry. No dominant mass, suspicious grouped microcalcification, or\nunexplained distortion is seen in the left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses.", + "output": "No specific evidence of malignancy in the left breast.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: There is a marker clip in the lateral middle depth from a recent\nbreast MRI biopsy. There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications.\n\nLeft breast: There is vascular calcifications. Marker clip from the recent\nbiopsy is identified in the subareolar left breast. There are no suspicious\ncalcifications in this area.\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the inferior medial right\nbreast was performed to follow-up the MR detected T2 bright ovoid enhancing 7\nmm lesion. There was no sonographic correlate to this finding.", + "output": "No mammographic evidence of malignancy although the patient has a known MR\ndetected and biopsied left breast micro invasive carcinoma and DCIS.\n\nNo mammographic or sonographic correlate to the benign-appearing enhancing\nmass in the inferior medial right breast. Imaging follow-up with MR is\nrecommended given the benign appearance. However if tissue diagnosis is\ndesired the biopsy should be with MRI guidance.\n\nRECOMMENDATION(S): Management of the known left malignancy per clinical team.\n\nEither MRI guided biopsy or follow-up for probably benign right breast\ninferior medial mass.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study. The findings were emailed to ___. ___, M.D. by\n___, M.D. on ___ at 3:16 pm.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: There is a marker clip in the lateral middle depth from a recent\nbreast MRI biopsy. There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications.\n\nLeft breast: There is vascular calcifications. Marker clip from the recent\nbiopsy is identified in the subareolar left breast. There are no suspicious\ncalcifications in this area.\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the inferior medial right\nbreast was performed to follow-up the MR detected T2 bright ovoid enhancing 7\nmm lesion. There was no sonographic correlate to this finding.", + "output": "No mammographic evidence of malignancy although the patient has a known MR\ndetected and biopsied left breast micro invasive carcinoma and DCIS.\n\nNo mammographic or sonographic correlate to the benign-appearing enhancing\nmass in the inferior medial right breast. Imaging follow-up with MR is\nrecommended given the benign appearance. However if tissue diagnosis is\ndesired the biopsy should be with MRI guidance.\n\nRECOMMENDATION(S): Management of the known left malignancy per clinical team.\n\nEither MRI guided biopsy or follow-up for probably benign right breast\ninferior medial mass.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study. The findings were emailed to ___. ___, M.D. by\n___, M.D. on ___ at 3:16 pm.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "There are at least 3 benign appearing nodes in the axilla adjacent to the\nlateral border of the pectoralis\ntendon. There is no adenopathy or abnormal mass.", + "output": "Normal appearance to the right axilla.\n\nRECOMMENDATION: Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "Targeted sonography of the superior left breast was performed. At 12 o'clock\n5-6 cm from nipple there are multiple adjacent areas of fat necrosis as\ndemonstrated by dense shadowing from rim calcification. The largest area\nmeasures 3.4 cm in the greatest diameter in the likely represents the palpable\nabnormality. There was no evidence of recurrent disease in this targeted\narea.", + "output": "Findings consistent with fat necrosis in the superior breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at the 7 o'clock\nposition of the left breast which was without any discrete suspicious solid or\ncystic masses.", + "output": "No specific mammographic evidence of malignancy. No sonographic abnormality\nin the area of clinical concern. In the absence of imaging findings, any\ndecision for further intervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at the 7 o'clock\nposition of the left breast which was without any discrete suspicious solid or\ncystic masses.", + "output": "No specific mammographic evidence of malignancy. No sonographic abnormality\nin the area of clinical concern. In the absence of imaging findings, any\ndecision for further intervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is an approximately 2 mm focal asymmetry in the upper-outer left breast\ncontaining a biopsy clip, not significantly changed since ___ and minimally\nlarger since ___. coarse appearing calcifications are seen throughout the\nleft breast, made many of which layer on the lateral view, consistent with\nmilk of calcium.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper-outer left breast was\nperformed. At 2 to 3:00 position 9 cm from the nipple there is a 1.8 x 0.8 x\n0.4 cm group of minimally complicated cysts, likely correlating to the focal\nasymmetry on the mammogram. At 2 to 3:00 position 6 cm from the nipple there\nis a group of microcysts measuring 8 x 5 x 8 mm.", + "output": "There are 2 probably benign masses in the upper-outer left breast, consisting\nof a minimally complicated cyst and a group of microcysts, likely apocrine\nmetaplasia.\n\nRECOMMENDATION(S): Six-month follow-up ultrasound of the left breast is\nrecommended to document stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 54, 49, and 46 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 56 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 46, 49, and 29 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.5.\nThe external carotid artery has peak systolic velocity of 62 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis bilaterally. No significant plaque noted." + }, + { + "input": "There are normal axillary lymph nodes in the right axilla. No suspicious\ncystic or solid masses.", + "output": "No suspicious cystic or solid masses or lymphadenopathy in the right axilla.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There is an approximately 14 mm focal\nasymmetry underneath the left nipple. Otherwise,\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. There are vascular calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the subareolar left breast was\nperformed, revealing multiple dilated ducts with no intraductal masses; these\ndilated ducts correlate to the mammographic asymmetry. No suspicious solid or\ncystic mass.", + "output": "No specific mammographic evidence of malignancy. Status post right\nmastectomy.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There is an approximately 14 mm focal\nasymmetry underneath the left nipple. Otherwise,\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. There are vascular calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the subareolar left breast was\nperformed, revealing multiple dilated ducts with no intraductal masses; these\ndilated ducts correlate to the mammographic asymmetry. No suspicious solid or\ncystic mass.", + "output": "No specific mammographic evidence of malignancy. Status post right\nmastectomy.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Ultrasound of the reconstructed right breast from ___ o'clock 1-8 cm from the\nnipple in the area of concern as indicated by the patient was performed. This\nidentified a 0.5 cm superficial cyst as well as a larger area of heterogeneous\nechotexture containing some echogenic areas suggestive of calcifications. The\nimaging appearance would favor a benign process such as fat necrosis but\ncorrelation with mammography to confirm this diagnosis would be recommended.\nTherefore, mammography of the reconstructed right breast was subsequently\nperformed.\n\nThe breast tissue is predominately fatty. There are multiple surgical clips.\nThere has been interval development of coarse dystrophic like calcifications\nin an area of previously seen lucency, which includes the area of concern as\nindicated by the patient. Therefore, the findings are consistent with fat\nnecrosis and no further imaging evaluation is necessary at this time.", + "output": "Heterogeneous area in the reconstructed right breast corresponding to\nmammographic findings consistent with fat necrosis in the area of concern as\nindicated by the patient. No specific mammographic evidence of malignancy\nwithin the reconstructed right breast. No further imaging followup for this\nfinding is advised at this time.\n\nRECOMMENDATION: The patient is due for mammography of her left breast in\n___.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "Ultrasound of the reconstructed right breast from ___ o'clock 1-8 cm from the\nnipple in the area of concern as indicated by the patient was performed. This\nidentified a 0.5 cm superficial cyst as well as a larger area of heterogeneous\nechotexture containing some echogenic areas suggestive of calcifications. The\nimaging appearance would favor a benign process such as fat necrosis but\ncorrelation with mammography to confirm this diagnosis would be recommended.\nTherefore, mammography of the reconstructed right breast was subsequently\nperformed.\n\nThe breast tissue is predominately fatty. There are multiple surgical clips.\nThere has been interval development of coarse dystrophic like calcifications\nin an area of previously seen lucency, which includes the area of concern as\nindicated by the patient. Therefore, the findings are consistent with fat\nnecrosis and no further imaging evaluation is necessary at this time.", + "output": "Heterogeneous area in the reconstructed right breast corresponding to\nmammographic findings consistent with fat necrosis in the area of concern as\nindicated by the patient. No specific mammographic evidence of malignancy\nwithin the reconstructed right breast. No further imaging followup for this\nfinding is advised at this time.\n\nRECOMMENDATION: The patient is due for mammography of her left breast in\n___.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is no atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 70.2 cm/s / 14.3 cm/s\nCCA Distal: 41.6 cm/s / 14 cm/s\nICA ___: 31 cm/s / 15.2 cm/s\nICA Mid: 36.9 cm/s / 18.2 cm/s\nICA Distal: 48.2 cm/s / 18.7 cm/s\nECA: 51.1 cm/s\nVertebral: 30.5 cm/s\n\nICA/CCA Ratio: 1.16\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is no atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 76.7 cm/s / 16.7 cm/s\nCCA Distal: 49.1 cm/s / 11.3 cm/s\nICA ___: 32.9 cm/s / 14.7 cm/s\nICA Mid: 36.9 cm/s / 14.3 cm/s\nICA Distal: 53.1 cm/s / 24.1 cm/s\nECA: 55.5 cm/s\nVertebral: 49.1 cm/s\n\nICA/CCA Ratio: 1.08\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Bilateral normal carotid duplex." + }, + { + "input": "Small volume complex fluid collection within the right deltoid muscle appears\nsmaller in volume in comparison to recent MRI and ultrasound although direct\ncomparison with MRI is difficult. There is increased vascularity on color\nDoppler imaging within and about the collection, suggestive of synovitis. \nImages demonstrate needle within this collection.", + "output": "Technically successful right deltoid fluid collection aspiration." + }, + { + "input": "Within the superficial subcutaneous soft tissues of the anterior left lower\nextremity, there is a complex fluid collection with internal debris measuring\n6.3 x 5.5 x 3.8 cm. No internal vascularity was seen There is equivocal mild\nperipheral increased vascularity", + "output": "Avascular complex fluid collection with internal debris and equivocal\nperipheral vascularity measures up to 6.3 cm and appears most consistent with\na hematoma. Infection cannot be excluded." + }, + { + "input": "Preprocedure ultrasound demonstrated 2 distinct pockets of fluid, 1 of which\nwas slightly more tubular measuring 3.4 x 2.1 cm. Second was seen more cranial\nand likely represented some periovarian free fluid, measuring 2.0 x 4.4 cm.\nBoth were targeted and aspirated.", + "output": "Successful US-guided drainage of left tubo-ovarian abscess and small amount\nof left periovarian free fluid as detailed above. Samples were sent for\nmicrobiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 73, 104, and 99 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 111 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 60 for, 82, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 72 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous plaque involving the internal carotid arteries on both\nsides. No evidence of hemodynamically significant stenoses on either side\n(less than 40%).\nNormal antegrade flow both vertebral arteries." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: right lower quadrant\nFluid: 0.6 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory for the requested\nanalysis (chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 0.6 L of fluid were removed and sent for analysis." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\n\nThere are no suspicious grouped calcifications, or unexplained architectural\ndistortion. Post biopsy clip seen in the left breast stable. Benign\ncalcifications seen in both breasts.\n\n\nLEFT BREAST ULTRASOUND: US FINDING\n\nThere is a 0.4 x 0.3 x 0.4 cm solid lobular mass with calcifications re-\ndemonstrated at 12 o'clock position, 3-4 cm from the nipple, stable when\ncompared to previous ultrasound from ___ with measurements of 0.3 x\n0.4 x 0.4 cm.\n\nNo other abnormality seen in either breast.", + "output": "Solid mass with calcifications in the left breast at 12 o'clock position,\nstable which most likely represent involuting fibroadenoma. 1 more year of\nfollowup with mammogram ultrasound is recommended to ensure stability.\n\nRECOMMENDATION: 1 more year of followup with mammogram ultrasound is\nrecommended to ensure stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA ribbon biopsy clip in the upper central left breast is from a biopsy proven\nfibroadenoma. An adjacent asymmetry on the MLO view has the appearance of\nnormal breast tissue on 90 degree lateral and spot compression views performed\ntoday. Multiple coarse calcifications are present in both breasts. There is\nno concerning mass, suspicious clustered microcalcifications or architectural\ndistortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 12 o'clock 4 cm\nfrom the nipple was performed. The mass is hypoechoic contains echogenic foci\nconsistent with calcifications and is stable in size since ___,\nconsistent with ___ years of stability. Currently the lesion measures 0.5 x\n0.5 x 0.4 cm, having previously measured 0.4 x 0.4 x 0.5 cm in ___.\n\nThe biopsied fibroadenoma is again identified at 12 o'clock 6 cm from the\nnipple, 1.3 cm superior to the non biopsied mass and is stable.\n\nScanning of the entire upper left breast to evaluate the left breast asymmetry\nseen on mammography did not reveal an ultrasound correlate.", + "output": "___ year stability of a left breast mass at 12 o'clock 4 cm from the nipple.\n\nRECOMMENDATION(S): Given long-term stability, no additional followup is\nnecessary for the left breast mass at 12 o'clock 4 cm from the nipple. Age\nand risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nAdditional views confirm the presence of a 5 x 4 mm oval circumscribed mass in\nthe right retroareolar region, smaller compared to ___. There are\nmultiple benign-appearing calcifications, the largest is 9 mm.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 1 o'clock 1 cm\nfrom the nipple demonstrates a 5 x 5 x 4 mm oval circumscribed isoechoic mass\nwith a subtle hypoechoic rim, without dominant vascularity or posterior\nshadowing. This has the appearance of a small oil cyst.", + "output": "Probably benign 5 mm right breast mass at 1 o'clock, likely and noncalcified\noil cyst.\n\nRECOMMENDATION(S): Six-month follow-up right breast ultrasound\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient and\nher daughter, who agree with the plan. She was given information to schedule\nher follow-up right breast ultrasound.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted sonography of the right breast at 1 o'clock 1 cm from nipple\nre-demonstrates a 5 x 4 x 5 mm mass which has a hyperechoic center and a\nhypoechoic rim. There is an adjacent blood vessel. The appearance is most\ncompatible with an intramammary lymph node. This is unchanged. Alternatively\nthis may be an evolving oil cyst.", + "output": "Stable appearance of the probably benign 5 mm right breast mass at 1 o'clock. \nThis may be an intramammary lymph node. The final check in 6 months at the\ntime of her routine mammography is reasonable.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and right breast ultrasound\nin 6 months\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight: The prior right breast retroareolar mass is less apparent on today's\nimaging. Benign calcifications are seen in the retroareolar region including\na 0.8 cm calcified fibroadenoma and other benign calcifications. There is no\nsuspicious dominant mass, architectural distortion or suspicious grouped\ncalcification.\n\nLeft: The left breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications. Multiple\nbenign-appearing calcifications are again present. There is a ribbon clip\nseen in the left upper outer quadrant.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at 1 o'clock\n1 cm from the nipple demonstrates a 3 x 3 x 4 mm hyperechoic mass with a thin\nhypoechoic rim, likely a noncalcified oil cyst. This is smaller compared to\nthe prior studies, and most consistent with a benign entity. Also seen\nincidentally, is the 7 x 8 mm calcified fibroadenoma at 12 o'clock 3 cm from\nthe nipple.", + "output": "Interval decrease in the size of the prior probably benign right retroareolar\nlesion at 1 o'clock now measuring 3 x 3 x 4 mm. Continued follow-up is\nrecommended in ___ year.\nNo specific evidence of malignancy in either breast.\n\nRECOMMENDATION(S): ___ year follow-up diagnostic mammogram and right breast\nultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "There is normal flow with respiratory variation in the bilateral subclavian\nveins.\n\nThe left internal jugular, axillary, and brachial veins are patent, show\nnormal color flow, spectral doppler, and compressibility. The left basilic,\nand cephalic veins are patent, compressible and show normal color flow.\n\nA AV fistula is seen in the left antecubital fossa. Heterogeneous echogenic\nmaterial within the venous component of the fistula without flow extends to\nthe left axilla, where a stent is seen and also completely occluded..", + "output": "1. No evidence of deep vein thrombosis in the left upper extremity.\n2. Complete occlusion the venous component of the left upper extremity AV\nfistula extending from the left antecubital fossa to the left axilla including\nthe stent in the axilla.\n\nNOTIFICATION: The findings were discussed by ___, M.D. with\n___ N.P. on the telephoneon ___ at 6:54 am, 15 minutes after\ndiscovery of the findings." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated\nmoderate pleural fluid. A suitable target in the deepest pocket in the right\nposterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine buffered with\nsodium bicarbonate was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 1.5 L of straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided thoracocentesis aspirating 1.5 L of\nstraw-colored fluid." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications seen in either breast. There is a ribbon\nclip overlying the left pectoralis on MLO view from prior benign biopsy.\n\nTargeted ultrasound of the left retroareolar region was performed with\nattention to the area of prior reported pain. No discrete cystic or solid\nmass is seen.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Annual screening mammography. Final disposition of any\npersistent clinical findings should be based on clinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications seen in either breast. There is a ribbon\nclip overlying the left pectoralis on MLO view from prior benign biopsy.\n\nTargeted ultrasound of the left retroareolar region was performed with\nattention to the area of prior reported pain. No discrete cystic or solid\nmass is seen.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Annual screening mammography. Final disposition of any\npersistent clinical findings should be based on clinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Initial ultrasound images demonstrated a 4.1 x 2.6 x 2.6 cm avascular\ncollection containing fluid and hypoechoic debris within the right parotid\ngland. Post aspiration images show a small residual collection containing\nhypoechoic debris.", + "output": "Technically successful aspiration of the right parotid collection with sample\nsent for microbiology." + }, + { + "input": "There is again a heterogeneous hypoechoic collection in the right parotid with\nminor cystic components measuring 3.0 x 4.4 x 2.7 cm, increased from the post\naspiration images yesterday, and grossly similar in size to the the initial\nimages. Following aspiration, the residual hypoechoic collection measures 3.3\nx 1.7 cm. No further aspiration was possible.", + "output": "Successful US-guided FNA and repeat aspiration of the right parotid\ncollection. Samples were submitted for microbiology and cytology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal heterogeneous atherosclerotic plaque\nin the right internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 65, 63, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.76.\nThe external carotid artery has peak systolic velocity of 81 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 57, 60, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.77.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No stenosis in the bilateral internal carotid arteries." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA 3 mm circumscribed mass persists in the central outer left breast at middle\ndepth and was further evaluated by ultrasound. There are no suspicious\ngrouped microcalcifications or architectural distortion\n\nBREAST ULTRASOUND: Ultrasound was performed in the area of concern on\nmammography. At 2 o'clock 3 cm from the nipple there is a 0.3 x 0.2 x 0.2 cm\nprobable minimally complicated cyst however on real-time scanning the margins\nwere slightly ill-defined likely due to the small size. Six-month follow-up\nultrasound seems reasonable at this time.", + "output": "Probable complicated cyst corresponding to the mass on mammography for which\nsix-month follow-up ultrasound is recommended.\n\nRECOMMENDATION(S): Left breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA 3 mm circumscribed mass persists in the central outer left breast at middle\ndepth and was further evaluated by ultrasound. There are no suspicious\ngrouped microcalcifications or architectural distortion\n\nBREAST ULTRASOUND: Ultrasound was performed in the area of concern on\nmammography. At 2 o'clock 3 cm from the nipple there is a 0.3 x 0.2 x 0.2 cm\nprobable minimally complicated cyst however on real-time scanning the margins\nwere slightly ill-defined likely due to the small size. Six-month follow-up\nultrasound seems reasonable at this time.", + "output": "Probable complicated cyst corresponding to the mass on mammography for which\nsix-month follow-up ultrasound is recommended.\n\nRECOMMENDATION(S): Left breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Similar to the prior study at 2 o'clock 3 cm from nipple there is a hypo to\nanechoic tiny mass measuring today 0.3 x 0.2 x 0.2 cm. Continued follow-up is\nrecommended.", + "output": "Stable appearance of the likely complicated cyst at 2 o'clock in the left\nbreast for which continued follow-up is recommended.\n\nRECOMMENDATION(S): Left breast ultrasound and bilateral diagnostic mammogram\nin 6 months\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nAgain seen in the left breast is a small 3 mm circumscribed mass in the\ncentral outer breast which is unchanged mammographically compared to ___. Otherwise there is no suspicious mass, suspicious grouped\nmicrocalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of the\npreviously identified abnormality. Again seen at 2 o'clock 3 cm from the\nnipple is a 0.2 x 0.3 x 0.2 cm nearly anechoic mass likely representing a\nminimally complicated cyst and corresponding to the finding on mammography. \nThis has not changed in appearance compared to ___.", + "output": "1. ___ year stability of probably benign mass in the left breast for which\ncontinued follow-up in ___ year with mammography and ultrasound is recommended.\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and left breast ultrasound\nin ___ year.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nAgain seen in the left breast is a small 3 mm circumscribed mass in the\ncentral outer breast which is unchanged mammographically compared to ___. Otherwise there is no suspicious mass, suspicious grouped\nmicrocalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of the\npreviously identified abnormality. Again seen at 2 o'clock 3 cm from the\nnipple is a 0.2 x 0.3 x 0.2 cm nearly anechoic mass likely representing a\nminimally complicated cyst and corresponding to the finding on mammography. \nThis has not changed in appearance compared to ___.", + "output": "1. ___ year stability of probably benign mass in the left breast for which\ncontinued follow-up in ___ year with mammography and ultrasound is recommended.\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and left breast ultrasound\nin ___ year.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Again seen in the left breast at 3 o'clock 6 cm from the nipple is hypoechoic\nmass unchanged from previous imaging\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by Dr. ___.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Again seen in the left breast at 3 o'clock 6 cm from the nipple is hypoechoic\nmass unchanged from previous imaging\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by Dr. ___.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications in either breast.\n\nLEFT BREAST ULTRASOUND:\nTargeted ultrasound of the left breast was performed in the area of prior pain\nindicated by the patient. The breast was scanned from 3:00 to 9:00, 0-8 cm\nfrom the nipple. At 3 o'clock, 5 cm from the nipple, there is a patch of\nhypoechoic tissue with no significant internal vascularity measuring 1.1 x 0.6\nx 0.8 cm. This may represent a normal fat lobule, but appears to stand out\nfrom adjacent tissue on real-time scanning. Ultrasound-guided core biopsy is\nrecommended to confirm benignity.", + "output": "A 1.1 cm patch of hypoechoic tissue in the left breast at 3 o'clock may\nrepresent a normal fat lobule, but appears to stand out from adjacent tissue\non real-time scanning. Ultrasound-guided core biopsy is recommended to\nconfirm benignity.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 16:40 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications in either breast.\n\nLEFT BREAST ULTRASOUND:\nTargeted ultrasound of the left breast was performed in the area of prior pain\nindicated by the patient. The breast was scanned from 3:00 to 9:00, 0-8 cm\nfrom the nipple. At 3 o'clock, 5 cm from the nipple, there is a patch of\nhypoechoic tissue with no significant internal vascularity measuring 1.1 x 0.6\nx 0.8 cm. This may represent a normal fat lobule, but appears to stand out\nfrom adjacent tissue on real-time scanning. Ultrasound-guided core biopsy is\nrecommended to confirm benignity.", + "output": "A 1.1 cm patch of hypoechoic tissue in the left breast at 3 o'clock may\nrepresent a normal fat lobule, but appears to stand out from adjacent tissue\non real-time scanning. Ultrasound-guided core biopsy is recommended to\nconfirm benignity.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 16:40 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissues are heterogeneously dense and\nsomewhat nodular which lowers the sensitivity of mammography and could\nconceivably obscure a lesion. There is a stable benign appearing mass in the\nupper outer posterior left breast likely representing an intramammary node. \nThe two groups of calcifications in the right breast do not appear to be\nsignificantly changed and overall appear to be coarsening suggestive of a\nbenign process. Continued followup imaging in one year seems reasonable at\nthis time. No area of architectural distortion is appreciated in either\nbreast.\n\nUltrasound of the right breast at 12:00 1-10 cm from the nipple identifies a\nfluctuating cystic area at 11 o'clock 5 cm from the nipple measuring\napproximately 0.8 x 0.3 x 0.8 cm. This favors a benign process such as a\napocrine metaplasia and continued followup imaging in one year seems\nreasonable at this time. The other previously identified lesion at 11:30 4 cm\nfrom the nipple is not identified on today's study.", + "output": "Stable probable benign right breast calcifications and stable probable benign\ncystic changes in the right breast at 11 o'clock for which continued followup\nimaging in one year seems reasonable at this time.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. There is a stable benign appearing intramammary node in\nthe upper outer posterior left breast. The calcifications in the outer right\nbreast are stable consistent with a benign finding. No further imaging\nfollowup is necessary at this time. The small mass in the anterior right\nbreast seen on the prior study ___ is no longer apparent. No\nsuspicious mass or area of architectural distortion is appreciated in either\nbreast.\n\nUltrasound of the right breast from ___ o'clock 1-10 cm from the nipple in\nthe area of concern on prior imaging was performed. The previously identified\narea of presumed cystic change is no longer apparent. No solid suspicious\nmass is seen. The patient may resume routine screening.", + "output": "Benign right breast calcifications. Interval resolution of cystic changes in\nthe right breast at 11 o'clock. No specific mammographic evidence of\nmalignancy. The patient may resume routine screening.\n\nRECOMMENDATION: Annual mammography\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. The\npatient prefers to undergo routine mammography at the ___.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. There is a stable benign appearing intramammary node in\nthe upper outer posterior left breast. The calcifications in the outer right\nbreast are stable consistent with a benign finding. No further imaging\nfollowup is necessary at this time. The small mass in the anterior right\nbreast seen on the prior study ___ is no longer apparent. No\nsuspicious mass or area of architectural distortion is appreciated in either\nbreast.\n\nUltrasound of the right breast from ___ o'clock 1-10 cm from the nipple in\nthe area of concern on prior imaging was performed. The previously identified\narea of presumed cystic change is no longer apparent. No solid suspicious\nmass is seen. The patient may resume routine screening.", + "output": "Benign right breast calcifications. Interval resolution of cystic changes in\nthe right breast at 11 o'clock. No specific mammographic evidence of\nmalignancy. The patient may resume routine screening.\n\nRECOMMENDATION: Annual mammography\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. The\npatient prefers to undergo routine mammography at the ___.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nPatient complained of moderate biopsy site pain postprocedure. Limited\npostprocedure ultrasound demonstrated no perihepatic hematoma or other\ncomplication. Vital signs were stable and patient was otherwise asymptomatic.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n13 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe focal asymmetry in the left upper outer retroareolar breast persists on\nspot compression views however is unchanged from the prior mammogram from ___ likely represents benign breast tissue. Ultrasound was performed\nfor further evaluation. The questioned focal asymmetry in the right upper\nouter breast at anterior depth persists on the CC view where there is a 0.5 cm\nasymmetry in the outer breast at anterior depth however does not persist on\nthe MLO view. Ultrasound was performed for further evaluation. There are no\nsuspicious calcifications or architectural distortion in either breast.\n\nBILATERAL BREAST ULTRASOUND: Targeted ultrasound was performed of the left\nbreast in the area of concern on mammography. At 2 o'clock 1 cm from the\nnipple there is a patch of dense breast tissue corresponding to the\nmammographic finding. No suspicious solid or cystic mass was identified.\n\nTargeted ultrasound was performed of the right outer breast from ___ o'clock\n0-5 cm from the nipple in the area of concern on mammography. At 10 o'clock 2\ncm from the nipple there is a 0.5 x 0.7 x 0.2 cm oval, parallel, hypoechoic\nmass that is slightly more prominent than adjacent fat lobules that may\nrepresent a fat lobule or a small probably benign mass.", + "output": "1. Questioned focal asymmetry in the left breast is unchanged since ___ and\ncompatible benign dense breast tissue. No specific evidence of malignancy in\nthe left breast.\n2. Probably benign mass in the right breast which may correspond to an\nasymmetry in the lateral breast on mammography. Six-month follow-up mammogram\nand ultrasound is recommended to document stability.\n\nRECOMMENDATION(S): Right diagnostic mammogram and right breast ultrasound in\n6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up. \nThe patient did indicate that she prefers to return in one year for follow-up\nof this finding. The recommendation for six-month follow-up was emphasized.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe focal asymmetry in the left upper outer retroareolar breast persists on\nspot compression views however is unchanged from the prior mammogram from ___ likely represents benign breast tissue. Ultrasound was performed\nfor further evaluation. The questioned focal asymmetry in the right upper\nouter breast at anterior depth persists on the CC view where there is a 0.5 cm\nasymmetry in the outer breast at anterior depth however does not persist on\nthe MLO view. Ultrasound was performed for further evaluation. There are no\nsuspicious calcifications or architectural distortion in either breast.\n\nBILATERAL BREAST ULTRASOUND: Targeted ultrasound was performed of the left\nbreast in the area of concern on mammography. At 2 o'clock 1 cm from the\nnipple there is a patch of dense breast tissue corresponding to the\nmammographic finding. No suspicious solid or cystic mass was identified.\n\nTargeted ultrasound was performed of the right outer breast from ___ o'clock\n0-5 cm from the nipple in the area of concern on mammography. At 10 o'clock 2\ncm from the nipple there is a 0.5 x 0.7 x 0.2 cm oval, parallel, hypoechoic\nmass that is slightly more prominent than adjacent fat lobules that may\nrepresent a fat lobule or a small probably benign mass.", + "output": "1. Questioned focal asymmetry in the left breast is unchanged since ___ and\ncompatible benign dense breast tissue. No specific evidence of malignancy in\nthe left breast.\n2. Probably benign mass in the right breast which may correspond to an\nasymmetry in the lateral breast on mammography. Six-month follow-up mammogram\nand ultrasound is recommended to document stability.\n\nRECOMMENDATION(S): Right diagnostic mammogram and right breast ultrasound in\n6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up. \nThe patient did indicate that she prefers to return in one year for follow-up\nof this finding. The recommendation for six-month follow-up was emphasized.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate mixed atherosclerotic plaque, most\npronounced in the carotid bulb.\nThe peak systolic velocity in the right common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 95, 87, and 83 cm/sec, respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 134 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate mixed atherosclerotic plaque, most\npronounced in the carotid bulb.\nThe peak systolic velocity in the left common carotid artery is 70 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 55, 81, and 87 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 119 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Extensive atherosclerotic plaque most pronounced in the bilateral carotid\nbulbs without flow-limiting stenosis (<40%). Given the patient's plaque\nburden, followup in ___ years is recommended." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM: Tissue density: C - The breast tissue is\nheterogeneously dense which may obscure detection of small masses.\nAgain seen is the well-circumscribed oval mass in the right outer slightly\nupper breast at posterior depth measuring approximately 7 mm. No suspicious\ngrouped microcalcifications or architectural distortion.\n\nRIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed in\nthe outer right breast. At 11 o'clock, 6-7 cm from the nipple, there is a\nfairly well-circumscribed oval hypoechoic nodule measuring 7 x 5 x 4 mm\nwithout significant internal vascularity and without significant through\ntransmission or posterior shadowing. At 9 o'clock, 10 cm from the nipple,\nthere is a 5 mm benign appearing lymph node.", + "output": "7 mm fairly well-circumscribed oval hypoechoic nodule in the outer slightly\nupper right breast at 11 o'clock, 6-7 cm from the nipple.\n\n5 mm benign appearing lymph node in the outer right breast at 9 o'clock, 10 cm\nfrom the nipple.\n\nIt is unclear which of these lesions corresponds to the mammographic finding.\nRecommend ultrasound-guided core biopsy of the 7 mm hypoechoic nodule.\n\nRECOMMENDATION: Ultrasound-directed core biopsy\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "A hypoechoic 7 mm mass is seen in the right breast at 11 o'clock, 6-7 cm from\nthe nipple.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\n\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\n\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: Dr ___ performed the procedure. Dr\n___ assisted Dr ___ the procedure.\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views of the right breast\ndemonstrate a ribbon clip in the upper outer quadrant. The clip is anterior\nto the mass seen on mammography. As the clip was seen to deploy in the\nsonographic mass on ultrasound, the mammographic and sonographic findings are\nconfirmed to not be the same lesion.", + "output": "Technically successful US-guided core biopsy of right breast 11:00 mass\nidentified by ultrasound. Post procedure mammogram confirmed the sonographic\nfinding to be different from the mammographic finding. Final disposition of\nthe mammographic finding will be dependent on pathology results. This was\ndiscussed with the patient at the completion of the exam.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient." + }, + { + "input": "A hypoechoic 7 mm mass is seen in the right breast at 11 o'clock, 6-7 cm from\nthe nipple.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\n\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\n\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: Dr ___ performed the procedure. Dr\n___ assisted Dr ___ the procedure.\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views of the right breast\ndemonstrate a ribbon clip in the upper outer quadrant. The clip is anterior\nto the mass seen on mammography. As the clip was seen to deploy in the\nsonographic mass on ultrasound, the mammographic and sonographic findings are\nconfirmed to not be the same lesion.", + "output": "Technically successful US-guided core biopsy of right breast 11:00 mass\nidentified by ultrasound. Post procedure mammogram confirmed the sonographic\nfinding to be different from the mammographic finding. Final disposition of\nthe mammographic finding will be dependent on pathology results. This was\ndiscussed with the patient at the completion of the exam.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient." + }, + { + "input": "Imaging in the left groin demonstrates the left common femoral vein and artery\nto be patent. Normal phasic venous wave forms are noted within the common\nfemoral vein as well as arterial waveforms noted within the common femoral\nartery. No pseudoaneurysm is identified. No hematoma was seen.", + "output": "No evidence of left groin pseudoaneurysm or hematoma." + }, + { + "input": "There is normal compressibility and flow of the bilateral common femoral,\nfemoral, and popliteal veins. Normal color flow and compressibility are\ndemonstrated in the posterior tibial and peroneal veins.\n\nThere is normal respiratory variation in the common femoral veins bilaterally.\n\nNo evidence of medial popliteal fossa (___) cyst.", + "output": "No evidence of deep venous thrombosis in the right or left lower extremity\nveins." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 117 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 87, 93, and 99 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 0.8..\nThe external carotid artery has peak systolic velocity of 130 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 105 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 91, 93, and 85 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 97 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of internal carotid artery stenosis bilaterally." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is a 3 mm group of punctate microcalcifications within the central left\nbreast at mid depth, adjacent to a ribbon clip, which were not definitively\nseen on prior examinations. No suspicious mass or unexplained architectural\ndistortion within either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the bilateral retroareolar regions\nwas performed which was without any discrete suspicious solid or cystic\nmasses.", + "output": "1. 3 mm group of punctate microcalcifications within the central left breast,\nnot definitively visualized on prior examinations, probably benign.\n2. No abnormalities within the retroareolar region bilaterally to explain the\nbilateral burning sensation. Any decision for further intervention should be\nbased on the clinical assessment.\n\nRECOMMENDATION(S): Left breast follow-up mammogram in 6 months. Clinical\nfollow-up is recommended for the bilateral nipple burning sensation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy with the assistance of an interpreter.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "The aorta measures 1.9 cm in the proximal portion, 1.8 cm in mid portion and\n1.8 cm in the distal abdominal aorta. No aneurysm.\n\nWall-to-wall color flow is seen within aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.9 cm and the left common iliac artery\nmeasures 0.7 cm.\n\nThe right kidney measures 10.5 cm and the left kidney measures 11.2 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "No abdominal aortic aneurysm, although note is made of the lack of tapering of\nthe mid to distal aorta which is normally seen.\n\nRECOMMENDATION(S): Consider surveillance ultrasound in ___ years." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated\nmoderate pleural fluid. A suitable target in the deepest pocket in the right\nposterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 1.1 L of serosanguineous fluid was removed.\nFluid samples were submitted to the laboratory for cell count, differential,\nchemistry and culture, as well as cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Successful ultrasound-guided thoracentesis on the right with approximately 1.1\nL of serosanguineous fluid removed and sent to the laboratory for evaluation." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 15\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy. The specimen was provided to the\npathology resident." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has intimal wall thickening without significant\natherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 88.5 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 48.4, 50.6, and 50.1 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 13.3 cm/sec.\nThe ICA/CCA ratio is 0.57.\nThe external carotid artery has peak systolic velocity of 64.8 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has intimal wall thickening. There is mild\ncalcified, shadowing atherosclerotic plaque in the proximal left ICA at the\nbulb.\nThe peak systolic velocity in the left common carotid artery is 73.5 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 51.5, 50.2, and 42.9 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 13.3 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 48.4 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis bilaterally." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 0.4 L of clear green yellow fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "Ultrasound-guided paracentesis. 0.4 L of clear greenish yellow fluid was\nremoved and samples were submitted to the laboratory for analysis." + }, + { + "input": "Distended gallbladder with shadowing stones in the gallbladder neck.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Sample sent for microbiology evaluation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.25 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.25 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Left lower quadrant\nFluid: 5 L of turbid straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.0 L of blood tinged, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.0 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.2 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.1 L of choose 1 fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.1 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of mildly cloudy, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of blood-tinged, yellow fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 3.6 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Left lower quadrant\nFluid: 4900 cc of clear light orange fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA total of 4900 cc of clear light orange ascites fluid was aspirated via a 5\n___ catheter advanced into the largest fluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Successful ultrasound-guided left lower quadrant therapeutic paracentesis\nwith a total of 4900 cc clear light orange ascites fluid removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.4 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Right upper quadrant\nFluid: 4.6 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4.5 L of amber colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5 L of serosanguinousfluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis. 5 L of\nserosanguineous fluid was drained. No immediate complications." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.6 L of amber colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.6 L of fluid were removed and sent for analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the mid lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Mid lower quadrant\nFluid: 4.7 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and verbal consent was obtained due to COVID-19 precautions.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4.6 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and verbal consent was obtained due to COVID-19 precautions.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and verbal consent was obtained due to COVID-19 precautions.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed and sent for analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and verbal consent was obtained due to COVID-19 precautions.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed and sent for analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.6 L of cloudy, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and verbal consent was obtained due to COVID-19 precautions.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.0 L of slightly cloudy, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.0 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of blood-tinged, yellow fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.2 L of clear, blood-tinged fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4.2 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory for the requested\nanalysis.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis with removal of 4 L of straw-colored fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites in all four quadrants. A suitable target in the deepest\npocket in the left lower quadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the Right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Right lower quadrant\nFluid: 4.25 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.25 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the therapeutic\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4 L of clear straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "A preprocedure ultrasound showed a lobulated left axillary lymph node. After\nadministering local anesthesia, a coaxial needle was advanced towards the\nlesion. Subsequently 2 core biopsies were performed under ultrasound\nguidance. After removing the coaxial needle, 4 more core biopsies were\nperformed under ultrasound guidance. The patient tolerated the procedure\nwell.", + "output": "Successful ultrasound-guided biopsy of left axillary lymph node." + }, + { + "input": "There are mild edematous changes within the breast tissue predominantly\ncentered around ___ o'clock in the area of prior lumpectomy. No solid\nsuspicious mass or cystic lesion is seen. Imaging of the right axillary region\ndid not identify any pathologic lymphadenopathy. Further management of the\npatient's symptoms at this time should be based on the clinical assessment.", + "output": "Mild edematous changes in the outer central to lower right breast\ncorresponding to the area of prior lumpectomy consistent with expected post\ntreatment change. No focal axillary abnormality. Further management of the\npatient's symptoms at this time should be based on the clinical assessment.\n\nRECOMMENDATION: Clinical followup. Annual diagnostic mammography in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging. The\npatient will follow-up with Dr. ___.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are posttreatment changes in the breast. There has been interval\ncoarsening rim calcifications in the lumpectomy bed, consistent with fat\nnecrosis. Additional diffuse microcalcifications are unchanged without a\nsuspicious grouping. There is no suspicious dominant mass or unexplained\narchitectural distortion.\nNo significant mammographic finding underlying the triangle radiopaque marker\ndenoting the site of pain in her outer right breast.\n\nBREAST ULTRASOUND: Targeted right breast ultrasound was performed in multiple\nareas of pain as directed by the patient scanning the breast at 9 o'clock 13\ncm from the nipple, 8 o'clock 20 cm from the nipple, 8 o'clock 10 cm from\nnipple, 7 o'clock 10 cm from nipple, and 10 o'clock cm from the nipple. There\nis no suspicious mass or significant ultrasound finding correlating to the\nareas of pain", + "output": "1. Interval coarsening of rim calcifications the lumpectomy bed consistent\nwith fat necrosis. No mammographic specific evidence of malignancy in the\nright breast.\n2. Normal targeted right breast ultrasound.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are posttreatment changes in the breast. There has been interval\ncoarsening rim calcifications in the lumpectomy bed, consistent with fat\nnecrosis. Additional diffuse microcalcifications are unchanged without a\nsuspicious grouping. There is no suspicious dominant mass or unexplained\narchitectural distortion.\nNo significant mammographic finding underlying the triangle radiopaque marker\ndenoting the site of pain in her outer right breast.\n\nBREAST ULTRASOUND: Targeted right breast ultrasound was performed in multiple\nareas of pain as directed by the patient scanning the breast at 9 o'clock 13\ncm from the nipple, 8 o'clock 20 cm from the nipple, 8 o'clock 10 cm from\nnipple, 7 o'clock 10 cm from nipple, and 10 o'clock cm from the nipple. There\nis no suspicious mass or significant ultrasound finding correlating to the\nareas of pain", + "output": "1. Interval coarsening of rim calcifications the lumpectomy bed consistent\nwith fat necrosis. No mammographic specific evidence of malignancy in the\nright breast.\n2. Normal targeted right breast ultrasound.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight breast: Benign stable postsurgical changes are noted in the right upper\nouter breast. Surgical clips are also noted in the right axilla. A\ntriangular BB marks area of pain. There is no discrete mass underlying the\nBB. There are no spiculated masses suspicious grouped microcalcifications or\nunexplained areas of architectural distortion.\nLeft breast: There are innumerable scattered benign-appearing stable\nmicrocalcifications throughout the left breast. A well-circumscribed mass in\nthe left upper outer breast is stable dating back to ___ with layering\ncalcifications consistent with milk of calcium consistent with a cyst is seen\non the MRI of ___.. There is no other dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications. There is\nno significant change.\n\nTargeted left breast ultrasound: Targeted ultrasound of the right breast was\nperformed. The right breast was scanned over the area of pain which is from\n___ o'clock and the right retroareolar region was scanned. No discrete solid\nor cystic mass was seen.", + "output": "No evidence of malignancy. Benign stable postsurgical changes.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight breast: Benign stable postsurgical changes are noted in the right upper\nouter breast. Surgical clips are also noted in the right axilla. A\ntriangular BB marks area of pain. There is no discrete mass underlying the\nBB. There are no spiculated masses suspicious grouped microcalcifications or\nunexplained areas of architectural distortion.\nLeft breast: There are innumerable scattered benign-appearing stable\nmicrocalcifications throughout the left breast. A well-circumscribed mass in\nthe left upper outer breast is stable dating back to ___ with layering\ncalcifications consistent with milk of calcium consistent with a cyst is seen\non the MRI of ___.. There is no other dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications. There is\nno significant change.\n\nTargeted left breast ultrasound: Targeted ultrasound of the right breast was\nperformed. The right breast was scanned over the area of pain which is from\n___ o'clock and the right retroareolar region was scanned. No discrete solid\nor cystic mass was seen.", + "output": "No evidence of malignancy. Benign stable postsurgical changes.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n17 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 127 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 115, 77, and 80 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 136 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has minimal atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 112 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 58, 95, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 0.84.\nThe external carotid artery has peak systolic velocity of 102 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Minimal left atherosclerosis. Normal velocities bilaterally without stenosis." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is a 9 mm circumscribed mass in the right upper outer quadrant at middle\ndepth with an adjacent 6 mm circumscribed mass. There are no associated\nmicrocalcifications. The larger lesion likely represents enlargement of the\nprior cyst. The smaller lesion has an appearance suggestive of an\nintramammary lymph node, and measured 5 mm in ___.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at ___ o'clock\n2-3 cm from the nipple demonstrates a a 7 mm are cyst with micro lobulated\nmargins. In the adjacent tissue is an oval circumscribed 5 x 3 x 5 mm\nhypoechoic mass which is without definitive echogenic hilum, but has a benign\nappearance. The differential includes a cyst with debris.", + "output": "Enlargement of the right breast cyst which is remarkable for micro\nlobulations. Consideration could be given to aspiration for definitive\nconfirmation. No evidence of malignancy.\n\nRECOMMENDATION(S): Right breast cyst aspiration.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nultrasound. The patient agrees with this plan and aspiration was subsequently\nperformed.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the right breast at 10 o'clock, 3 cm from the nipple\ndemonstrates a 6 x 7 x 6 mm round hypoechoic mass with through transmission\nand no internal vascularity, consistent with a simple cyst, targeted for cyst\naspiration.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD (___), and V. ___, M.D.\n(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the lesion and less than\n1 cc of black fluid was aspirated. The fluid was discarded due to lack of\nsuspicion. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast cyst.", + "output": "Technically successful US-guided aspiration of a simple right breast cyst.\n\nFindings reviewed with the patient at the completion of the aspiration.\n\nStandard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation.\n\nRECOMMENDATION(S): Annual mammography." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, a 17 gauge coaxial biopsy needle was advanced into the right lobe of\nthe liver. The inner stylet was removed and an 18 gauge core biopsy needle\nwas advanced through the 17 gauge needle and 6 core biopsy samples were\nobtained: 4 were placed in MEM solution and 2 were placed in formalin (sent\nfor pathology and culture). The Gel-Foam was injected into the hepatic access\ntract through 17 Gage needle as it was withdrawn. The skin was then cleaned\nand a dry sterile dressing was applied. The patient tolerated the procedure\nwell and there were no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of\n75/23 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n59/11 cm/sec in its proximal portion, 75/17 cm/sec in its mid portion and\n55/17 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 80cm/sec.\nThe vertebral artery has peak systolic velocity of 83 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.0.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe left common carotid artery had peak systolic/diastolic velocities of 84/21\ncm/sec.\nThe left internal carotid artery had peak systolic/diastolic velocities of\n70/19 cm/sec in its proximal portion, 70/20 cm/sec in its mid portion and\n78/23 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 103cm/sec.\nThe vertebral artery has peak systolic velocity of 65 cm/sec with retrograde\n(reversed) flow, consistent with steal syndrome.\nThe left ICA/CCA ratio is 0.92.", + "output": "1. No carotid plaque burden identified. No significant stenosis of the\ninternal carotid arteries.\n2. Reversal of flow in the left vertebral artery, consistent with subclavian\nsteal syndrome." + }, + { + "input": "The liver appears normal in echotexture and size without focal lesion. There\nis no evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder contains multiple mobile shadowing gallstones with no evidence of\nacute cholecystitis, particularly no gallbladder distention, gallbladder wall\nthickening or pericholecystic fluid. Evaluation of the pancreas is limited by\noverlying bowel gas. The spleen measures 13.8 cm, top-normal in size, and has\nhomogenous echotexture. Representative images of the right kidney are normal.\nThe right kidney measures 11.8 cm. Visualized portions of the aorta and IVC\nare normal. ___ sign not assessed.", + "output": "Cholelithiasis, without convincing signs of acute cholecystitis." + }, + { + "input": "Targeted ultrasound was performed of the entire left breast from ___ o'clock\n0-6 cm from the nipple. Breast tissue is identified compatible with\ngynecomastia. This is what corresponds to the increased tracer on the PET-CT.\nAt 12 o'clock in the retroareolar region there is a small 0.4 x 0.2 x 0.5 cm\noval circumscribed hypoechoic mass with mild internal vascularity which may\nrepresent a normal intramammary lymph node, however given the history of a\nmass in the left breast that has decreased in size after treatment for\nlymphoma, this mass is indeterminate. Recommend correlation with prior\nimaging. If tissue diagnosis is desired this can be targeted for\nultrasound-guided biopsy.", + "output": "1. Left breast gynecomastia which corresponds to the increased uptake on the\nrecent PET-CT.\n2. Small mass in the left breast at 12 o'clock which on real-time scanning was\nthought to represent an intramammary lymph node however after the exam, the\nclinical history that the patient had an indeterminate mass in the left breast\nat outside institution that decreased in size after chemotherapy was provided.\nTherefore, this mass is indeterminate. Comparison to prior imaging from\noutside institution is recommended. If definite tissue diagnosis is desired,\nthis can be targeted for ultrasound-guided biopsy.\n\nRECOMMENDATION(S): Comparison to prior imaging. If tissue diagnosis is\nrequired, this can be targeted for ultrasound-guided biopsy.\n\nNOTIFICATION: Findings discussed with ___ MD by ___, MD via\ntelephone on ___ at 16:40.\n\nBI-RADS: 0 Incomplete - Need Prior Mammograms for \nComparison." + }, + { + "input": "Again seen in the left breast at 12 o'clock is a hypoechoic oval-shaped mass\nabutting the back.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by Dr. ___.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy device\nand a 16 gauge ___ device. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss:\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM was deferred due to the patient's overall medical\nstatus as well as good visualization of the clip under ultrasound.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Complex hypoechoic region adjacent to the right greater trochanter, centered\nwithin the gluteus medius muscle and tendon. No discrete anechoic fluid was\nseen. This may reflect a phlegmon. Attempted aspiration yielded minimal\nfluid. Limited samples were sent to microbiology.", + "output": "Trace fluid aspirated from the hypoechoic region adjacent to the right greater\ntrochanter. Appearances likely reflect gluteal tendinosis and tearing,\npotentially a phlegmon could have this appearance but no anechoic fluid pocket\nwas seen." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\nBilateral postoperative changes are seen, which appears stable on the left\nbreast when compared to prior studies. However on the right side on MLO view\nthere is a new asymmetry on the lumpectomy site on the upper-outer quadrant,\nwhich correlates with seroma cavity on same day ultrasound correlate. There\nare no new dominant masses, suspicious microcalcifications, or unexplained\narchitectural distortion. Left breast periareolar asymmetry after spot\ncompression views, likely represents overlapping breast parenchyma, with no\nsonographic correlate on same day ultrasound. .\n\nBILATERAL BREAST ULTRASOUND:\n\nThere is a 2.9 x 2.4 x 5.5 cm well-circumscribed, seroma cavity in the right\nbreast at 12 o'clock position 3-5 cm from the nipple corresponding to same day\nmammographic findings, consistent with postoperative changes.\n\nNo sonographic abnormality seen in the left periareolar region to correspond\nwith asymmetry seen on same day spot compression views.\n\nNo other findings seen in either breast.", + "output": "No evidence of malignancy. Residual seroma cavity with fat necrosis on the\nupper-outer right breast. Bilateral postoperative changes.\n\nRECOMMENDATION: Surveillance mammogram in ___ year is recommended to\ndemonstrate stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses.\nBilateral postoperative changes are seen, which appears stable on the left\nbreast when compared to prior studies. However on the right side on MLO view\nthere is a new asymmetry on the lumpectomy site on the upper-outer quadrant,\nwhich correlates with seroma cavity on same day ultrasound correlate. There\nare no new dominant masses, suspicious microcalcifications, or unexplained\narchitectural distortion. Left breast periareolar asymmetry after spot\ncompression views, likely represents overlapping breast parenchyma, with no\nsonographic correlate on same day ultrasound. .\n\nBILATERAL BREAST ULTRASOUND:\n\nThere is a 2.9 x 2.4 x 5.5 cm well-circumscribed, seroma cavity in the right\nbreast at 12 o'clock position 3-5 cm from the nipple corresponding to same day\nmammographic findings, consistent with postoperative changes.\n\nNo sonographic abnormality seen in the left periareolar region to correspond\nwith asymmetry seen on same day spot compression views.\n\nNo other findings seen in either breast.", + "output": "No evidence of malignancy. Residual seroma cavity with fat necrosis on the\nupper-outer right breast. Bilateral postoperative changes.\n\nRECOMMENDATION: Surveillance mammogram in ___ year is recommended to\ndemonstrate stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the right breast at ___ o'clock 4 cm from the nipple,\nat the patient's surgical scar, demonstrates the seroma cavity measuring 3.2 x\n2.4 x 3.1 cm. Within the seroma cavity is a heterogeneous hypoechoic oval\nmass measuring 2.1 x 1.3 x 1.5 cm, with dominant vascularity along the\nanterior margin.", + "output": "2.1 cm heterogeneous hypoechoic oval mass with dominant vascularity within the\n3.2 cm seroma cavity right breast 12 o'clock. While this may represent\ngranulation tissue, ultrasound core biopsy is recommended for definitive\npathology.\n\nRECOMMENDATION(S): Right breast ultrasound-guided core biopsy with clip\nplacement.\nThe patient is also due for mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. Right ultrasound-guided core biopsy was scheduled for\nlater same day as planned.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Again seen in the right breast at ___ o'clock is an anechoic fluid\ncollection measuring 3.3 x 2.7 x 2.7 cm. In the anterior portion of it is a\nhypoechoic 2.1 cm mass which was the target biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___.\n___, M.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was used to drain 6 cc of yellow\nseroma fluid from around the lesion. Following this, a 14-gauge Bard\nspring-loaded biopsy device, 5 cores were obtained of the hypoechoic mass. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nThe patient has same day bilateral diagnostic mammogram which demonstrates the\nclip was accurately placed in this lesion.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nWhen the results are available the radiology department breast imaging nurse\n___ call the patient with pathology findings and recommendations. Standard\npost care instructions were provided to the patient." + }, + { + "input": "X per noncontrast, non vascular head CT there is no large hematoma. There is\nan aneurysm clip the left MCA position. There is bifrontal pneumocephalus. \nThere is some subcutaneous fluid under this scalp flap.\n\nUltrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nLeft common carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral arteries and their distal\nterritories. There is no residual aneurysm the left MCA. There is filling of\nthe full MCA candelabra with no delayed in filling.. There is cross-filling\nacross the anterior communicating artery and filling the contralateral A 2\nsegment. This is confirmed on the three-dimensional rotational imaging.\n\nUltrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.", + "output": "No residual filling of the previously clipped left MCA aneurysm that was\nunruptured\n\nFilling of the bilateral M2 branches with good distal supply\n\nRECOMMENDATION(S):\n1. Continue to maintain flap with hypertension." + }, + { + "input": "Targeted ultrasound of the right axilla was performed. There are multiple\nabnormal appearing right axillary lymph nodes with associated cortical\nthickening, measuring up to 9 mm in cortical thickness.\n\nTargeted ultrasound of the left breast and axilla was performed. In the left\nbreast 2 to 3:00 position 4 cm from the nipple, there is in oval mass with\ncircumscribed margins and internal vascular flow on color Doppler as well as\nmildly heterogeneous internal echogenicity, which may represent an\nintramammary lymph node, measuring 8 x 5 x 5 mm. At the 2 o'clock position of\nthe left breast 6 cm from the nipple, there is a similar appearing smaller\nmass measuring 4 x 4 x 3 mm. In the left axilla, there are multiple lymph\nnodes with cortical thickening measuring up to 8 mm in thickness.", + "output": "Left breast masses are suspicious. Ultrasound-guided core biopsy of dominant\nleft breast mass at 2:00 to 3:00 position 4 cm from nipple is recommended. \nManagement of smaller similar appearing mass to be determined based on\npathology results.\n\nBilateral axillary lymphadenopathy with associated cortical thickening is\nsuspicious. While this may be related to reactive hyperplasia or systemic\ninfectious or inflammatory processes, malignancy, including lymphoma and\nmetastatic disease should be excluded.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of dominant left breast mass\nand left axillary lymph node seems reasonable.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan. She was given information to schedule her\nbiopsy for next ___ at 15:00. in addition, findings and\nrecommendation were transmitted by the critical results communication system\nto Dr. ___ at 11:32 ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "In the left breast at ___ o'clock 4 cm from the nipple, there is circumscribed\nhypoechoic mass with internal vascularity that measures 0.9 x 0.5 x 0.5 cm for\nwhich ultrasound-guided core needle biopsy will be performed.\n\nIn the left axilla there are 2 abnormal lymph nodes with cortical thickness of\n0.6 cm. Targeted ultrasound guided core needle biopsy of the more superficial\nlymph node will be performed.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD. ___ procedure was supervised by ___, M.D.\n(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the left breast\nlesion and 5 cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved. Due to\ncontinued bleeding from the entry site, pressure was held for approximately 10\nminutes. A moderate sized approximately 3 x 3 cm hematoma formed at the\nbiopsy site.\n\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the left axillary lymph node and 6 cores\nwere obtained using a 14-gauge Sertera spring-loaded biopsy device. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 10 cc.\nSpecimens: Sent to pathology and cytopathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: The patient tolerated the procedure well, but had a moderate\nhematoma in the left breast, which was controlled prior to discharge.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement of the left breast clip.", + "output": "Technically successful US-guided core biopsy of the left breast mass and left\naxillary lymph node. Pathology and cytology are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "In the left breast at ___ o'clock 4 cm from the nipple, there is circumscribed\nhypoechoic mass with internal vascularity that measures 0.9 x 0.5 x 0.5 cm for\nwhich ultrasound-guided core needle biopsy will be performed.\n\nIn the left axilla there are 2 abnormal lymph nodes with cortical thickness of\n0.6 cm. Targeted ultrasound guided core needle biopsy of the more superficial\nlymph node will be performed.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD. ___ procedure was supervised by ___, M.D.\n(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the left breast\nlesion and 5 cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved. Due to\ncontinued bleeding from the entry site, pressure was held for approximately 10\nminutes. A moderate sized approximately 3 x 3 cm hematoma formed at the\nbiopsy site.\n\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the left axillary lymph node and 6 cores\nwere obtained using a 14-gauge Sertera spring-loaded biopsy device. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 10 cc.\nSpecimens: Sent to pathology and cytopathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: The patient tolerated the procedure well, but had a moderate\nhematoma in the left breast, which was controlled prior to discharge.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement of the left breast clip.", + "output": "Technically successful US-guided core biopsy of the left breast mass and left\naxillary lymph node. Pathology and cytology are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRIGHT BREAST: There is no dominant mass, suspicious grouped\nmicrocalcifications, or unexplained architectural distortion. Prominent\naxillary lymph nodes are again demonstrated. Intramammary lymph node again\nseen within the upper outer right breast stable since ___. No new\nor enlarging mass, unexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST: Biopsy clip is identified within a circumscribed mass in the left\nouter slightly upper breast at mid depth corresponding to biopsy proven\nfollicular hyperplasia. There is re-demonstration of a round circumscribed\nmass in the upper outer left breast at mid to posterior depth best seen on CC\ntomosynthesis image 39. This mass appears to have some internal fat\nsuggesting that it is an intramammary lymph node. No new or enlarging mass,\nunexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 2 o'clock 6 cm\nfrom the nipple again demonstrates an avascular hypoechoic circumscribed oval\nmass measuring 0.5 x 0.3 x 0.5 cm which is not significantly different from\nthe prior study given differences in technique for measurement.", + "output": "No mammographic evidence of malignancy within either breast.\n\n12 month stability of probably benign mass 2 o'clock left breast 6 cm from the\nnipple which most likely represents a prominent intramammary lymph node. \nAdditional 12 month ultrasound recommended to ensure stability. The patient\nwill be due for mammographic evaluation of both breasts at that time.\n\nRECOMMENDATION(S): 12 month diagnostic mammogram with left breast ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRIGHT BREAST: There is no dominant mass, suspicious grouped\nmicrocalcifications, or unexplained architectural distortion. Prominent\naxillary lymph nodes are again demonstrated. Intramammary lymph node again\nseen within the upper outer right breast stable since ___. No new\nor enlarging mass, unexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST: Biopsy clip is identified within a circumscribed mass in the left\nouter slightly upper breast at mid depth corresponding to biopsy proven\nfollicular hyperplasia. There is re-demonstration of a round circumscribed\nmass in the upper outer left breast at mid to posterior depth best seen on CC\ntomosynthesis image 39. This mass appears to have some internal fat\nsuggesting that it is an intramammary lymph node. No new or enlarging mass,\nunexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 2 o'clock 6 cm\nfrom the nipple again demonstrates an avascular hypoechoic circumscribed oval\nmass measuring 0.5 x 0.3 x 0.5 cm which is not significantly different from\nthe prior study given differences in technique for measurement.", + "output": "No mammographic evidence of malignancy within either breast.\n\n12 month stability of probably benign mass 2 o'clock left breast 6 cm from the\nnipple which most likely represents a prominent intramammary lymph node. \nAdditional 12 month ultrasound recommended to ensure stability. The patient\nwill be due for mammographic evaluation of both breasts at that time.\n\nRECOMMENDATION(S): 12 month diagnostic mammogram with left breast ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 0.5 L of dark brown fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 0.5 L of fluid were removed with samples sent for cell count, chemistry,\nand microbiology." + }, + { + "input": "Limited preprocedural ultrasound demonstrated a large pocket fluid within the\nright lower quadrant.", + "output": "Successful US-guided placement of ___ pigtail catheter into pelvis for\ndrainage of ascites." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 70 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 60, 40, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.86.\nThe external carotid artery has peak systolic velocity of 77 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 101, 107, and 107 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 77 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the right internal carotid artery.\nLess than 40% stenosis of the left internal carotid artery." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 61.6 cm/s / 12.9 cm/s\nCCA Distal: 69.8 cm/s / 15.2 cm/s\nICA ___: 62.1 cm/s / 14.1 cm/s\nICA Mid: 57.5 cm/s / 19.3 cm/s\nICA Distal: 73.9 cm/s / 21.1 cm/s\nECA: 107 cm/s\nVertebral: 43.9 cm/s\n\nICA/CCA Ratio: 1.06\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 80.9 cm/s / 18.8 cm/s\nCCA Distal: 75.6 cm/s / 18.8 cm/s\nICA ___: 123 cm/s / 35.8 cm/s\nICA Mid: 137 cm/s / 29.1 cm/s\nICA Distal: 78.7 cm/s / 23.5 cm/s\nECA: 99.1 cm/s\nVertebral: 63.3 cm/s\n\n\nICA/CCA Ratio: 1.81\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA 40-59% stenosis." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM: Tissue density: C - The breast tissue is\nheterogeneously dense which may obscure detection of small masses.\nThere is a vague opacity measuring approximately 1.2 cm in length in the right\naxilla which persists on spot compression views. No suspicious mass in the\nright breast, no grouped microcalcifications or architectural distortion.\nRIGHT AXILLARY ULTRASOUND: Targeted ultrasound was performed of the right\naxilla. There is a heterogeneously hypoechoic lesion within the skin\nmeasuring approximately 1.2 cm x 0.7 x 0.4 cm with internal and surrounding\nvascularity, which corresponds to the mammographic finding, and likely\nrepresents an infected sebaceous cyst.", + "output": "Asymmetry in the right axilla Likely due to infected sebaceous cyst in the\nright axilla seen on mammogram and ultrasound.\n\nRECOMMENDATION: 6 week followup ultrasound of the right axilla. Final\ndisposition of this finding should be done on a clinical basis.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM: Tissue density: C - The breast tissue is\nheterogeneously dense which may obscure detection of small masses.\nThere is a vague opacity measuring approximately 1.2 cm in length in the right\naxilla which persists on spot compression views. No suspicious mass in the\nright breast, no grouped microcalcifications or architectural distortion.\nRIGHT AXILLARY ULTRASOUND: Targeted ultrasound was performed of the right\naxilla. There is a heterogeneously hypoechoic lesion within the skin\nmeasuring approximately 1.2 cm x 0.7 x 0.4 cm with internal and surrounding\nvascularity, which corresponds to the mammographic finding, and likely\nrepresents an infected sebaceous cyst.", + "output": "Asymmetry in the right axilla Likely due to infected sebaceous cyst in the\nright axilla seen on mammogram and ultrasound.\n\nRECOMMENDATION: 6 week followup ultrasound of the right axilla. Final\ndisposition of this finding should be done on a clinical basis.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the right axilla in the prior area of palpable concern\ndemonstrates interval resolution of previously described heterogeneous\nhypoechoic superficial skin lesion. No suspicious solid or cystic mass is\nappreciated.", + "output": "Interval resolution of presumed infected sebaceous cyst in the right axilla.\n\nRECOMMENDATION: No further followup imaging is recommended. The patient may\nreturn to annual mammographic surveillance.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nBilateral circumscribed masses are noted consistent with known history of\ncysts. In the left breast, in the area of clinical concern, there is a 1.3 x\n1.8 x 1.3 cm circumscribed mass that was further evaluated with ultrasound.\n\nLEFT BREAST ULTRASOUND: At 10 o'clock 7 cm from the nipple there is a 1.3 x\n1.9 x 1.7 cm macro lobulated anechoic mass with no internal vascularity that\nis consistent with a simple cyst. This is located in the area of clinical\nconcern correlates well with the mammographic finding.", + "output": "Area of clinical concern in the left breast correlates with a simple cyst.\n\nRECOMMENDATION(S): Age and risk appropriate mammography. Clinical followup\nfor the left breast cyst.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nBilateral circumscribed masses are noted consistent with known history of\ncysts. In the left breast, in the area of clinical concern, there is a 1.3 x\n1.8 x 1.3 cm circumscribed mass that was further evaluated with ultrasound.\n\nLEFT BREAST ULTRASOUND: At 10 o'clock 7 cm from the nipple there is a 1.3 x\n1.9 x 1.7 cm macro lobulated anechoic mass with no internal vascularity that\nis consistent with a simple cyst. This is located in the area of clinical\nconcern correlates well with the mammographic finding.", + "output": "Area of clinical concern in the left breast correlates with a simple cyst.\n\nRECOMMENDATION(S): Age and risk appropriate mammography. Clinical followup\nfor the left breast cyst.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is a 3.1 x 2.5 x 1 cm oval, hypoechoic mass at the 1 o'clock position of\nthe left breast approximately 3 cm from the nipple which was felt to possibly\ncorrespond to the area of diagnostic mammographic architectural distortion in\nthe slightly upper, slightly outer left breast.\n\nThere is a 1.4 x 1.5 x 1.3 cm irregular, hypoechoic mass/abnormal axillary\nlymph node with an anti parallel orientation within the left mid axilla.\n\nMultiple, enlarged, abnormal appearing lymph nodes in the left axilla are\nidentified.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: The procedure was performed by Dr. ___ MD(attending).\n\nDescription:\nLESION 1 (left breast; 1 o'clock, 3 cm from the nipple): Using ultrasound\nguidance, aseptic technique and local anesthesia, a 13-gaugecoaxial needle was\nplaced adjacent to the lesion and multiple cores were obtained using a\n14-gauge Sertera spring-loaded biopsy device. Next, a percutaneous HydroMark\ncoil was deployed under ultrasound guidance. The needle was removed and\nhemostasis was achieved.\n\nLESION 2 (mid axillary mass/abnormal left axillary lymph node): Using\nultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and multiple cores\nwere obtained using a 14-gauge Sertera spring-loaded biopsy device. Next, a\npercutaneous CeleroMark dumbbell was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nLESION 3 (enlarged and abnormal appearing left axillary lymph node): Using\nultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and multiple cores\nwere obtained using a 14-gauge Sertera spring-loaded biopsy device. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 5 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof both clips.", + "output": "Technically successful US-guided core biopsy of the left breast\nlesions/axillary node. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRIGHT BREAST: A subtle area of architectural distortion previously seen in the\nupper outer right breast did not persist on additional imaging today.. This\narea was further evaluated by ultrasound. Posterior to this area are seen a\nwell-circumscribed mass and a focal asymmetry, which are unchanged from ___,\nconsistent with benign processes. There is no suspicious mass or grouped\nmicrocalcifications.\n\nLEFT BREAST: Re-demonstrated are numerous abnormally enlarged axillary lymph\nnodes. Again noted is a 2.2 x 2.8 cm spiculated mass anterior to the axillary\nlymph nodes, extending into the axillary tail. Additionally, there is a mass\nin the upper outer left breast adjacent to a partially calcified vessel, which\nmeasures 1.1 x 0.6 cm. Persistent architectural distortion is seen in the\nslightly upper, slightly outer left breast noted with extra imaging. Note is\nmade of skin thickening involving the areola. There is no suspicious group of\nmicrocalcifications.\n\nBILATERAL BREAST ULTRASOUND:\n\nRIGHT BREAST: On physical examination of the right breast, a surgical scar is\nseen over the upper outer quadrant, related to remote excisional biopsy. No\nsuspicious solid or cystic mass is seen in the right breast.\n\nLEFT BREAST:\n\nAt 2 o'clock, 8 cm from the nipple there is a 1.3 x 1 x 0.4 cm oval parallel\nmacro lobulated hypoechoic mass with no internal vascularity or posterior\nfeatures. This mass is seen adjacent to a partially calcified vessel, and\ncorresponds to the mammographic mass in the upper outer left breast. This may\nbe an enlarged intramammary lymph node.\n\nAt 1 o'clock, 3 cm from the nipple there is an ill-defined hypoechoic area of\ndistortion which measures 3.1 x 2.5 x 1 cm, and does not demonstrate internal\nvascularity or posterior features. This may correlate to the area of\narchitectural distortion seen in the slightly upper, slightly outer breast on\nmammogram.\n\nIn the mid axilla, there is a 1.4 x 1.5 x 1.3 cm irregular anti parallel\nhypoechoic mass with indistinct margins. This mass demonstrates no internal\nvascularity or posterior features. This may correspond to the spiculated mass\nanterior to the axillary lymphadenopathy seen on mammogram.\n\nNumerous enlarged axillary lymph nodes are noted, measuring up to at least 3.6\nx 2.1 x 4.9 cm.", + "output": "LEFT BREAST:\n\n1. Area of architectural distortion in the slightly upper, slightly outer left\nbreast is suspicious. This may correspond to the ultrasound finding at 1\no'clock, 3 cm from the nipple, and ultrasound-guided core biopsy is\nrecommended.\n2. Suspicious mass in the mid axilla, which may represent an abnormal lymph\nnode versus primary breast mass. Ultrasound-guided core biopsy is\nrecommended.\n3. A suspicious mass in the left breast at 2 o'clock, 8 cm from the nipple. \nFurther management of this mass will depend on pathology results from above\ndescribed biopsies.\n4. Numerous enlarged axillary lymph nodes. Ultrasound-guided FNA of the\ndominant lymph node is recommended.\nRIGHT BREAST:\n\n1. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of left breast mass causing\ndistortion, irregular mass in the mid axilla, and ultrasound-guided FNA of a\nleft axillary lymph node.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study. She was scheduled for core biopsy/FNA\nimmediately following this examination.\n\nAdditionally, the findings and recommendations were communicated by emailed to\nDr. ___ by ___, M.D. on ___ at 12:10.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are 2 benign biopsy clips in the slightly upper outer left breast that\nare stable. Biopsy clip is in stable position in the low left axilla. \nAssociated with this clip is a biopsy proven spiculated malignancy with\ninterval decreased size that now measures 1.8 x 1.5 cm and previously measured\n3.8 x 2.7 cm. There is re-demonstration of a spiculated mass in the outer\nleft breast measuring 0.7 x 0.7 x 0.7 cm, previously measured 1.1 x 0.9 cm. \nThere are vascular calcifications. There is interval decreased prominence of\nleft axillary lymph nodes. These findings suggest partial response to\ntreatment.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the left axilla performed.\n\nThe large biopsied left axillary lymph node has decreased in size and measures\n3 x 2.2 by 1.2 cm, previously measured 4.9 x 3.6 x 2.1 cm.\n\nThe hypoechoic irregular mass in the left axilla with a Celero Mark clip has\ndecreased in size and measures 0.2 x 0.9 x 0.9 cm, previously measured 1.5 x\n1.4 x 1.3 cm.", + "output": "There is interval decrease in size of the biopsied masses in the left axilla\nas described above suggesting partial response to treatment. The previously\nidentified spiculated mass in the outer left breast has also decreased in size\nsuggesting partial response to treatment.\n\nRECOMMENDATION(S): Recommendations are per the oncologic and surgical teams.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are 2 benign biopsy clips in the slightly upper outer left breast that\nare stable. Biopsy clip is in stable position in the low left axilla. \nAssociated with this clip is a biopsy proven spiculated malignancy with\ninterval decreased size that now measures 1.8 x 1.5 cm and previously measured\n3.8 x 2.7 cm. There is re-demonstration of a spiculated mass in the outer\nleft breast measuring 0.7 x 0.7 x 0.7 cm, previously measured 1.1 x 0.9 cm. \nThere are vascular calcifications. There is interval decreased prominence of\nleft axillary lymph nodes. These findings suggest partial response to\ntreatment.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the left axilla performed.\n\nThe large biopsied left axillary lymph node has decreased in size and measures\n3 x 2.2 by 1.2 cm, previously measured 4.9 x 3.6 x 2.1 cm.\n\nThe hypoechoic irregular mass in the left axilla with a Celero Mark clip has\ndecreased in size and measures 0.2 x 0.9 x 0.9 cm, previously measured 1.5 x\n1.4 x 1.3 cm.", + "output": "There is interval decrease in size of the biopsied masses in the left axilla\nas described above suggesting partial response to treatment. The previously\nidentified spiculated mass in the outer left breast has also decreased in size\nsuggesting partial response to treatment.\n\nRECOMMENDATION(S): Recommendations are per the oncologic and surgical teams.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with some scattered\nmoderately dense fibroglandular and fibronodular tissue which does somewhat\nlower the sensitivity of mammography. Overall, there continues to be some\ndecrease in size of the multiple axillary lymph nodes as well as the\nspiculated mass surrounding theTrimark biopsy clip in the axillary tail of the\nleft breast. There is still at least one 2 cm abnormal appearing lymph node,\nalthough as compared to ___, all the lymph nodes are no longer as\ndense and all of them have decreased in size. Findings are consistent with\ncontinued treatment response. No suspicious grouped microcalcifications are\nappreciated. A ribbon biopsy clip is seen in the upper slightly outer left\nbreast at mid depth and a coil clip is seen in the central slightly upper left\nbreast. Vascular calcification is again identified.\n\nUltrasound of the left axilla and axillary tail was performed corresponding to\nthe areas of concern on prior imaging. This identified multiple small lymph\nnodes, some of which now have fatty hila. However, there is a persistent 1.7\nx 1.0 x 1.1 cm abnormal node which is felt to likely correspond to the\nabnormal appearing lymph node on mammography. In addition, ultrasound of the\nbiopsy site demonstrates a residual 0.7 by 0.6 x 0.9 cm mass surrounding the\nbiopsy clip.", + "output": "Continued interval decrease in size of multiple right axillary lymph nodes and\nright axillary tail biopsy-proven malignancy consistent with continued\ntreatment response.\n\nRECOMMENDATION: Follow-up imaging at this time should be based on the\nclinical assessment.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with some scattered\nmoderately dense fibroglandular and fibronodular tissue which does somewhat\nlower the sensitivity of mammography. Overall, there continues to be some\ndecrease in size of the multiple axillary lymph nodes as well as the\nspiculated mass surrounding theTrimark biopsy clip in the axillary tail of the\nleft breast. There is still at least one 2 cm abnormal appearing lymph node,\nalthough as compared to ___, all the lymph nodes are no longer as\ndense and all of them have decreased in size. Findings are consistent with\ncontinued treatment response. No suspicious grouped microcalcifications are\nappreciated. A ribbon biopsy clip is seen in the upper slightly outer left\nbreast at mid depth and a coil clip is seen in the central slightly upper left\nbreast. Vascular calcification is again identified.\n\nUltrasound of the left axilla and axillary tail was performed corresponding to\nthe areas of concern on prior imaging. This identified multiple small lymph\nnodes, some of which now have fatty hila. However, there is a persistent 1.7\nx 1.0 x 1.1 cm abnormal node which is felt to likely correspond to the\nabnormal appearing lymph node on mammography. In addition, ultrasound of the\nbiopsy site demonstrates a residual 0.7 by 0.6 x 0.9 cm mass surrounding the\nbiopsy clip.", + "output": "Continued interval decrease in size of multiple right axillary lymph nodes and\nright axillary tail biopsy-proven malignancy consistent with continued\ntreatment response.\n\nRECOMMENDATION: Follow-up imaging at this time should be based on the\nclinical assessment.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere are prominent parenchymal markings in both breasts bilaterally with\nasymmetric skin thickening of the left breast compared to the right. A left\nhemodialysis catheter is partially imaged. There are bilateral coarse\nmacrocalcifications as well as scattered bilateral microcalcifications. In\naddition, there are a few grouped right breast microcalcifications. There is\nno spiculated mass or unexplained architectural distortion in either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the left breast and\nleft axilla. There is subcutaneous edema and diffuse skin thickening most\npronounced in the dependent aspect of the breast without focal fluid\ncollection to suggest infection or abscess. Skin thickening measures up to 6\nmm in the left compared to 2 mm on the right. No suspicious solid or cystic\nlesions are identified.\n\nEvaluation of the left axilla demonstrates morphologically normal lymph nodes\nwithout cortical thickening, symmetric when compared to the right axilla.", + "output": "Bilateral, asymmetric, left greater than right skin thickening and edema. \nGiven the ___ medical history, and bilateral nature, this most likely\nrepresents a systemic process rather than left breast malignancy.\n\nRECOMMENDATION(S): Clinical correlation and followup is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 47 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 62, 63, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 63 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild to moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 26 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 35, 73, and 61. Cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 2.8.\nThe external carotid artery has peak systolic velocity of 67. Cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "Redemonstration of known enlarged left external iliac lymph nodes. A 1.9 x\n1.8 x 1.2 cm lymph node was targeted for biopsy.", + "output": "Technically successful core needle biopsy of an enlarged left external iliac\nlymph node." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight: A BB marker is placed over the upper central breast in the area of\nconcern as indicated by the patient. There is an approximately 1.3 cm\nsuspicious dense irregular mass underlying the BB marker. This was further\nevaluated with ultrasound. There are segmental pleomorphic calcifications\nextending laterally, anteriorly and inferiorly from the mass towards the\nnipple. The approximate extent of the calcifications is 7 cm from the mass\ntowards the nipple on the ML magnification view. The calcifications extend\napproximately 4 cm lateral to the mass. There are other benign secretory\ncalcifications in the anterior breast.\n\nLeft: There is no suspicious mass, suspicious grouped microcalcifications or\narchitectural distortion. There are benign-appearing calcifications in the\nleft breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of concern\nas indicated by the patient and on mammography. At 12 o'clock 8 cm from the\nnipple there is a 1.3 x 1.2 x 1.3 cm hypoechoic mass with angular and\nirregular margins and internal vascularity suspicious for malignancy. \nTargeted ultrasound was performed of the upper outer quadrant to identify the\ncalcifications however these were not confidently identified with sonography.", + "output": "1. Suspicious mass in the right breast at 12 o'clock for which\nultrasound-guided biopsy is recommended. The biopsy was performed after this\nexam.\n2. Suspicious segmental pleomorphic calcifications in the upper outer quadrant\nas described above. These are amenable to stereotactic core biopsy if\nclinically indicated to delineate extent of disease.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of right breast mass. Management\nof right breast calcifications will be determined once the biopsy results\nreturn.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient and her daughter who agrees with this plan. The biopsy was performed\nlater today.\n\n Findings emailed to ___, MD by ___, MD on ___\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight: A BB marker is placed over the upper central breast in the area of\nconcern as indicated by the patient. There is an approximately 1.3 cm\nsuspicious dense irregular mass underlying the BB marker. This was further\nevaluated with ultrasound. There are segmental pleomorphic calcifications\nextending laterally, anteriorly and inferiorly from the mass towards the\nnipple. The approximate extent of the calcifications is 7 cm from the mass\ntowards the nipple on the ML magnification view. The calcifications extend\napproximately 4 cm lateral to the mass. There are other benign secretory\ncalcifications in the anterior breast.\n\nLeft: There is no suspicious mass, suspicious grouped microcalcifications or\narchitectural distortion. There are benign-appearing calcifications in the\nleft breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of concern\nas indicated by the patient and on mammography. At 12 o'clock 8 cm from the\nnipple there is a 1.3 x 1.2 x 1.3 cm hypoechoic mass with angular and\nirregular margins and internal vascularity suspicious for malignancy. \nTargeted ultrasound was performed of the upper outer quadrant to identify the\ncalcifications however these were not confidently identified with sonography.", + "output": "1. Suspicious mass in the right breast at 12 o'clock for which\nultrasound-guided biopsy is recommended. The biopsy was performed after this\nexam.\n2. Suspicious segmental pleomorphic calcifications in the upper outer quadrant\nas described above. These are amenable to stereotactic core biopsy if\nclinically indicated to delineate extent of disease.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of right breast mass. Management\nof right breast calcifications will be determined once the biopsy results\nreturn.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient and her daughter who agrees with this plan. The biopsy was performed\nlater today.\n\n Findings emailed to ___, MD by ___, MD on ___\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Again seen in the right breast at 12 o'clock 8 cm from the nipple is an\nirregular hypoechoic mass.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by ___,\nM.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesions.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Again seen in the right breast at 12 o'clock 8 cm from the nipple is an\nirregular hypoechoic mass.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by ___,\nM.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesions.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere are no new suspicious findings in either breast. Specifically, no\ndominant masses, suspicious calcifications or areas of unexplained\narchitectural distortion is noted in either breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound in the area of reported palpable\nconcern was performed. In the 1 o'clock position approximately 4 cm from the\nnipple there is a 11 x 5 x 10 mm area with increased echogenicity with a\nnearly anechoic center and no increased vascularity. Directed physical\nexamination of the area of reported palpable concern reveals no definite\npalpable abnormalities at this time.", + "output": "1. There is an 11 mm area of increased echogenicity in the area of the\nreported palpable concern, probably corresponding to an area of fat necrosis/\nresolving hematoma in the the area of reported trauma. Short-term interval\nfollowup with a targeted ultrasound of this area in 6 months is recommended to\ndocument expected evolution/resolution. Clinical followup of the area of\npalpable concern is also recommended.\n\n2. No suspicious mammographic findings in the left breast.\n\nRECOMMENDATION: Short-term interval followup with a diagnostic mammogram of\nthe right breast in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Scanning in the region of the patient's palpable concern along the left mid\nback demonstrate a well demarcated, heterogenous yet echogenic lesion. This\nmeasures 2.5 x 2.2 x 1.3 cm, previously 1.8 x 0.9 x 1.8 cm. There is no\ninternal vascularity demonstrated within this structure.", + "output": "2.5 cm lesion in the soft tissues of the left mid back. This has changed in\nappearance when compared to prior ultrasound demonstrating increased\nheterogeneity and echogenicity. It also demonstrates larger ___ than on\nprior. Changes in appearance may suggest increased inflammation however,\nultrasound is not able to determine if these changes are meaningful.\n\nNOTIFICATION: The impression above was entered by ___ on\n___ at 14:46 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." + }, + { + "input": "Scanning in the region of the patient's palpable complaint in the superior\nright buttocks demonstrates a well demarcated, predominantly hyperechoic\nlesion measuring 2.3 x 1.3 x 2.3 cm. There is no internal vascularity\ndemonstrated within this structure.", + "output": "2.3 cm predominantly hyperechoic lesion in the soft tissues of the right\nsuperior buttocks. This has a similar appearance to the lesion scanned on the\nsame date in the soft tissues of the back." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n There are no developing masses. There are no areas of architectural\ndistortion or grouped/ suspicious calcifications.\nBREAST ULTRASOUND: Targeted ultrasound to the retroareolar portion of the\nbreast and in the area of the patient's pain shows no abnormality.", + "output": "No mammographic change in the appearance of the left breast. Also, no\nultrasound abnormality to account current symptoms.\n\nRECOMMENDATION: Clinical followup. The patient is due for screening\nmammography in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: The breast tissue is almost entirely fatty.\nFINDING: There is a circumscribed 0.3- 0.4 cm mass in the slightly upper and\nouter aspect of the breast at an anterior depth. There are additional areas\nof asymmetry but, otherwise, no circumscribed mass is proven on 2 projections\nLEFT BREAST ULTRASOUND: Scanning along the 3 o'clock axis and at a distance\nof 3 cm from the nipple, there is a small hypoechoic nodule which is not\nreproducible in 2 projections and is probably part of the ductal system. Along\nthe 2 o'clock axis and at a distance of 1-2 cm from the nipple, there is a 0.2\ncm anechoic nodule with no posterior features or associated vascularity. This\nmay correspond to the mammographic finding. No additional findings were seen\non today's ultrasound.", + "output": "A small circumscribed masses is confirmed on today's mammogram in the upper\nand outer aspect of the left breast which may correspond with a small\ncircumscribed anechoic mass, not definitely a cyst, on today's ultrasound.\n\nRECOMMENDATION: Six-month followup mammogram and ultrasound to reassess and\ninsure stability\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She was directed to scheduling prior to leaving the department.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC LEFT MAMMOGRAM WITH CAD:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nThe probably benign mass seen in the upper outer left breast is stable in\nappearance. Additional asymmetries are seen scattered throughout the left\nbreast that are unchanged in appearance. No suspicious microcalcifications or\nunexplained architectural distortion is noted.\n\nLEFT BREAST ULTRASOUND: At 2 o'clock 1 cm from the nipple there is a stable\n0.2 x 0.2 x 0.2 cm hypoechoic nodule with no internal vascularity.", + "output": "Six-month stability of probably benign left breast nodule.\n\nRECOMMENDATION: 6 month follow-up mammography and ultrasound is recommended. \nThe patient will be due for her annual mammogram at this time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nAgain seen is an approximately 3-4 mm oval circumscribed mass in the\nupper-outer left breast, unchanged since prior examination from ___. A sub cm asymmetry with several associated punctate calcifications in\nthe lower inner left breast is also stable dating back to at least ___.\n\nThere are no new suspicious grouped calcifications, areas of unexplained\narchitectural distortion or suspicious mass in either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. In\nthe 2 o'clock position 1 cm from the nipple again seen is a stable hypoechoic\noval mass measuring 3 x 2 x 1 mm. No suspicious cystic or solid masses are\nseen in the vicinity.", + "output": "___ year stability of probably benign mass in the upper-outer left breast and a\nprobably benign sub cm asymmetry with several associated punctate\ncalcifications in the lower inner left breast.\n\nRECOMMENDATION(S): Continued imaging followup in ___ year with bilateral\ndiagnostic mammogram and left breast ultrasound to document stability of the\nabove findings.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nA sub-4-mm, equal-density mass in the left upper outer breast at mid-anterior\ndepth is overall unchanged for ___ years. Other smaller nodular densities in\nthe left upper outer breast are also unchanged. A small asymmetry in the left\nlower inner breast with a few associated coarse calcifications is stable since\nat least ___. There is no evidence of a dominant mass in the right breast. \nThere is no evidence of architectural distortion or suspicious grouped\ncalcifications in either breast.\n\nTARGETED LEFT BREAST ULTRASOUND:\nAt 2:00, 1 cm from the nipple, there is a stable 0.2 x 0.1 x 0.2-cm hypoechoic\nlesion without internal vascularity. There is no evidence of a new discrete\nsuspicious solid or cystic mass.", + "output": "1. Probably benign sub-4-mm left upper outer breast mass, stable for at least\n___ years. Continued follow-up in ___ year to confirm ___ stability.\n\n2. Probably benign small left lower inner breast asymmetry with coarse\ncalcifications for at least ___ years. Continued follow-up in ___ year to confirm\n___ stability.\n\nRECOMMENDATION(S): Diagnostic mammogram for left breast mass and asymmetry\nand left breast ultrasound for left upper outer breast lesion in ___ year to\nconfirm ___ stability.\n\nAt this time, the patient will also be due for annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nA sub-4-mm, equal-density mass in the left upper outer breast at mid-anterior\ndepth is overall unchanged for ___ years. Other smaller nodular densities in the\nleft upper outer breast are also unchanged. A small asymmetry in the left\nlower inner breast with a few associated coarse calcifications is stable since\nat least ___. There is no evidence of a dominant mass in the right breast.\nThere is no evidence of architectural distortion or suspicious grouped\ncalcifications in either breast.\n\nTARGETED LEFT BREAST ULTRASOUND:\nAt 2:00, 1 cm from the nipple, there is a stable 0.2 x 0.1 x 0.2-cm hypoechoic\nlesion without internal vascularity. There is no evidence of a new discrete\nsuspicious solid or cystic mass.", + "output": "1. Probably benign sub-4-mm left upper outer breast mass, stable for at least\n___ years. Continued follow-up in ___ year to confirm ___ stability.\n\n2. Probably benign small left lower inner breast asymmetry with coarse\ncalcifications for at least ___ years. Continued follow-up in ___ year to confirm\n___ stability.\n RECOMMENDATION(S):\nDiagnostic mammogram for left breast mass and asymmetry and left breast\nultrasound for left upper outer breast lesion in ___ year to confirm ___\nstability.\n\nAt this time, the patient will also be due for annual mammography.\n NOTIFICATION:\nFindings and recommendation were reviewed with the patient who agrees with the\nplan. She was given information to schedule her follow-up.\n\n\n BI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are no suspicious microcalcifications, spiculated masses or areas of\nunexplained architectural change in either breast. Circumscribed nodularity\nin the left outer breast is stable. Asymmetry with associated round\ncalcifications in the lower inner left breast is unchanged compared with\nmagnification views dated ___ and likely unchanged compared with\nstandard views from ___. The remainder of the parenchymal pattern is stable.\n\n\nBREAST ULTRASOUND: Focused ultrasound of the previously followed masses in the\nleft breast at 2 o'clock periareolar was performed. Circumscribed oval\nhypoechoic structures in this axis measuring between 2 and 3 mm are unchanged.", + "output": "No specific mammographic evidence of malignancy. Stable small circumscribed\nmasses in the 2 o'clock left breast for ___ years. Stable asymmetry with\ncalcifications in the lower inner left breast for ___ years.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography is\nrecommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are no suspicious microcalcifications, spiculated masses or areas of\nunexplained architectural change in either breast. Circumscribed nodularity\nin the left outer breast is stable. Asymmetry with associated round\ncalcifications in the lower inner left breast is unchanged compared with\nmagnification views dated ___ and likely unchanged compared with\nstandard views from ___. The remainder of the parenchymal pattern is stable.\n\n\nBREAST ULTRASOUND: Focused ultrasound of the previously followed masses in the\nleft breast at 2 o'clock periareolar was performed. Circumscribed oval\nhypoechoic structures in this axis measuring between 2 and 3 mm are unchanged.", + "output": "No specific mammographic evidence of malignancy. Stable small circumscribed\nmasses in the 2 o'clock left breast for ___ years. Stable asymmetry with\ncalcifications in the lower inner left breast for ___ years.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography is\nrecommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "A limited left breast ultrasound was performed around the nipple which\ndemonstrates no evidence of abscess in normal breast tissue.", + "output": "Unremarkable limited left breast ultrasound demonstrate no evidence of\nabscess. The patient should be referred to the Breast Care ___ more\npossible additional imaging if the problem persists.\n\nNOTIFICATION: Unremarkable limited left breast ultrasound demonstrate no\nevidence of abscess. The patient should be referred to the Breast Care Center\nfor more extensive imaging if the problem persists.\n\nFINAL ASSESSMENT Unremarkable ultrasound." + }, + { + "input": "No solid suspicious or cystic mass is seen. No dilated ducts or intraductal\nlesions are appreciated. Further management of the patient's discharge at this\ntime should be based on the clinical assessment.", + "output": "No focal sonographic abnormality identified in the left retroareolar breast. \nFurther management of patient's discharge at this time should be based on the\nclinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The liver appears normal in grayscale appearance, size, without focal lesion.\nThere is no biliary ductal dilation with the common bile duct measuring 2 mm. \nThe main portal vein is patent with hepatopetal flow. The gallbladder appears\nnormal. The pancreas appears normal. The kidneys and spleen appear normal. \nNo ascites is seen.", + "output": "Unremarkable right upper quadrant ultrasound." + }, + { + "input": "Targeted ultrasound of the right breast is performed. The right inferior\nbreast was scanned from ___ o'clock. In the right breast at 9 o'clock 2-3 cm\nfrom the nipple is a fairly well-circumscribed mass with some posterior\nacoustic enhancement. It measures 0.7 x 0.4 x 0.5 cm and has a lobulation\nwithin. There is no central or peripheral vascularity. This likely corresponds\nto the mammographic abnormality.", + "output": "Solid mass in the right breast at 9 o'clock.\n\nRECOMMENDATION: Ultrasound-guided core biopsy recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy in the presence of for daughter who interpreted the study for her.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Multiple well-circumscribed, hypoechoic solid lesions are seen in the right\nbreast, measuring 4 x 6 x 5 mm at the 2 o'clock position 4 cm from the nipple,\n3 x 4 x 4 mm at the 12 o'clock position 4 cm from the nipple, 6 mm in diameter\nat the 12 o'clock position 1 cm from the nipple, and 3 x 2 x 2 mm at the 2\no'clock position 3 cm from the nipple. These lesions all demonstrate imaging\nfindings consistent with fibroadenomas. Additionally, the previously\nidentified well-circumscribed hypoechoic mass with posterior acoustic\nenhancement at the 9 o'clock position 2-3 cm from the nipple in the right\nbreast, without vascularity, is once again seen.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD, and ___, NP. The procedure was supervised\nby ___, M.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Multiple well-circumscribed, hypoechoic solid lesions are seen in the right\nbreast, measuring 4 x 6 x 5 mm at the 2 o'clock position 4 cm from the nipple,\n3 x 4 x 4 mm at the 12 o'clock position 4 cm from the nipple, 6 mm in diameter\nat the 12 o'clock position 1 cm from the nipple, and 3 x 2 x 2 mm at the 2\no'clock position 3 cm from the nipple. These lesions all demonstrate imaging\nfindings consistent with fibroadenomas. Additionally, the previously\nidentified well-circumscribed hypoechoic mass with posterior acoustic\nenhancement at the 9 o'clock position 2-3 cm from the nipple in the right\nbreast, without vascularity, is once again seen.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD, and ___, NP. The procedure was supervised\nby ___, M.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "At the 2 o'clock position 4 cm from the nipple, there is a stable hypoechoic\nnodule measuring 0.4 x 0.5 cm with no associated vascularity or shadowing.\nAt the 12 o'clock position of 4 cm from the nipple, there is a stable\nhypoechoic nodule lying at an anterior depth measuring 0.4 cm.\nAt the 12 o'clock position 1 cm from the nipple there is a likely cyst and a\nposterior depth measuring 0.6 x 0.7 cm. There is no associated vascularity or\nshadowing.", + "output": "There are 3 stable and probably benign nodules in the right breast. Two of\nthese are situated along the 12 o'clock axis of one along the 2 o'clock axis.\n\nRECOMMENDATION: Six-month followup targeted ultrasound. Routine screening\nmammography which the patient states she will schedule at ___. She\nwas given explicit instructions to schedule ultrasound following her routine\nmammogram in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At 12 o'clock, 1 cm from the nipple, there is a 0.7 x 0.6 x 0.6 cm round,\nhypoechoic mass without internal vascularity. It is unchanged in size from ___ when it measured 0.6 x 0.6 x 0.6 cm, but posterior acoustic\nshadowing is more apparent today than on prior studies without calcifications\non mammogram ___ to explain the shadowing. Biopsy of this lesion is\nrecommended.\n\nAt 12 o'clock, 4 cm from the nipple, there is a 0.3 x 0.3 x 0.4 cm round,\ncircumscribed, hypoechoic mass without internal vascularity or posterior\nacoustic features, unchanged from ___ when it measured 0.4 x 0.3 x\n0.4 cm, and probably benign.\n\nAt 2 o'clock, 4 cm from the nipple, there is a 0.4 x 0.4 x 0.5 cm round,\ncircumscribed, hypoechoic mass without internal vascularity or posterior\nfeatures, which is unchanged from ___ when it measured 0.6 x 0.4 x\n0.5 cm, and probably benign.\n\nUltrasound of the right axilla demonstrates morphologically normal appearing\nlymph nodes with normal cortical thickness.", + "output": "1. 0.7 cm mass at 12 o'clock, 1 cm from the nipple with posterior acoustic\nshadowing. Ultrasound-guided core biopsy of this mass is recommended.\n2. ___ year stability of smaller hypoechoic masses at 12 o'clock 4 cm from the\nnipple and at 2 o'clock 4 cm from the nipple. Followup right breast\nultrasound in ___ year is recommended, at which time the patient will be due for\nannual mammography.\n\nRECOMMENDATION(S): 1. Ultrasound-guided core biopsy of the right breast mass\nat 12 o'clock, 1 cm from the nipple.\n2. Right breast ultrasound in ___ year to evaluate for stability of additional\nright breast masses. At that time, the patient will be due for annual\nmammography.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient with the aid of an interpreter. The patient agrees with the plan. She\nwas given information to schedule her biopsy.\n\n The findings and recommendations were communicated to Dr. ___ to\n___ in Dr. ___ office on the telephone on ___ at 9:08 AM.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Right breast mass at 12 o'clock 1 cm from the nipple measuring 0.7 x 0.6 to\n0.7 cm. This was the target for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by V.\n___, M.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the right\nbreast lesion and using a 14-gauge Bard spring-loaded biopsy device, 6 cores\nwere obtained. Next, a percutaneous HydroMark coil was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. There is no definite mammographic correlate to the ultrasound\nfinding. In addition, a ribbon clip is seen from a prior procedure.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___ business\ndays.\n\nStandard post care instructions were provided to the patient." + }, + { + "input": "Right breast mass at 12 o'clock 1 cm from the nipple measuring 0.7 x 0.6 to\n0.7 cm. This was the target for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by V.\n___, M.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the right\nbreast lesion and using a 14-gauge Bard spring-loaded biopsy device, 6 cores\nwere obtained. Next, a percutaneous HydroMark coil was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. There is no definite mammographic correlate to the ultrasound\nfinding. In addition, a ribbon clip is seen from a prior procedure.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___ business\ndays.\n\nStandard post care instructions were provided to the patient." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are 2 biopsy clips in the right breast. There is no suspicious mass,\nunexplained architectural distortion or grouped microcalcification.\n\nBREAST ULTRASOUND: At the 2 o'clock position of the right breast 4 cm from\nthe nipple, there is a 5 x 5 x 4 mm hypoechoic mass which is not significantly\nchanged in comparison to the prior studies dating to ___ allowing for\ndifferences in measuring technique. At the 12 o'clock position of the right\nbreast 4 cm from the nipple, there is a 4 x 4 x 3 mm hypoechoic mass which is\nnot significantly changed in comparison to the prior studies dating to ___ allowing for differences in measuring technique.", + "output": "Stable right breast masses are probably benign not significantly changed since\n___. No specific mammographic evidence of malignancy in the left\nbreast.\n\nRECOMMENDATION(S): Continued follow-up in ___ year to assess for ___ year\nstability of right breast masses.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere are 2 biopsy clips in the right breast. There is no suspicious mass,\nunexplained architectural distortion or grouped microcalcification.\n\nBREAST ULTRASOUND: At the 2 o'clock position of the right breast 4 cm from\nthe nipple, there is a 5 x 5 x 4 mm hypoechoic mass which is not significantly\nchanged in comparison to the prior studies dating to ___ allowing for\ndifferences in measuring technique. At the 12 o'clock position of the right\nbreast 4 cm from the nipple, there is a 4 x 4 x 3 mm hypoechoic mass which is\nnot significantly changed in comparison to the prior studies dating to ___ allowing for differences in measuring technique.", + "output": "Stable right breast masses are probably benign not significantly changed since\n___. No specific mammographic evidence of malignancy in the left\nbreast.\n\nRECOMMENDATION(S): Continued follow-up in ___ year to assess for ___ year\nstability of right breast masses.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA 0.5 cm asymmetry is noted in the far posterior central breast on the left CC\nview only. Based on 3D imaging, this likely is located within the inferior\nbreast. This mass persists on spot compression views. No additional\nabnormalities identified in either breast.\n\nRIGHT BREAST ULTRASOUND: At 2 o'clock 4 cm from the nipple there is a 0.5 x\n0.4 x 0.5 cm hypoechoic mass that is stable since ___.\n\nAt 12 o'clock 4 cm from the nipple there is a 0.3 x 0.3 x 0.4 cm hypoechoic\nmass that is also stable since ___.\n\nLEFT BREAST ULTRASOUND: The left breast was scanned through the central axis\nfrom 12 through 6 o'clock through the nipple. At 6 o'clock 4 cm from the\nnipple there is a 0.5 x 0.2 x 0.4 cm circumscribed hypoechoic mass. This may\ncorrelate with the mammographic finding.", + "output": "___ year stability of probably benign right breast masses. New left breast mass\nthat is also probably benign was found.\n\nRECOMMENDATION(S): Six-month follow-up left breast ultrasound and mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA 0.5 cm asymmetry is noted in the far posterior central breast on the left CC\nview only. Based on 3D imaging, this likely is located within the inferior\nbreast. This mass persists on spot compression views. No additional\nabnormalities identified in either breast.\n\nRIGHT BREAST ULTRASOUND: At 2 o'clock 4 cm from the nipple there is a 0.5 x\n0.4 x 0.5 cm hypoechoic mass that is stable since ___.\n\nAt 12 o'clock 4 cm from the nipple there is a 0.3 x 0.3 x 0.4 cm hypoechoic\nmass that is also stable since ___.\n\nLEFT BREAST ULTRASOUND: The left breast was scanned through the central axis\nfrom 12 through 6 o'clock through the nipple. At 6 o'clock 4 cm from the\nnipple there is a 0.5 x 0.2 x 0.4 cm circumscribed hypoechoic mass. This may\ncorrelate with the mammographic finding.", + "output": "___ year stability of probably benign right breast masses. New left breast mass\nthat is also probably benign was found.\n\nRECOMMENDATION(S): Six-month follow-up left breast ultrasound and mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRe-demonstrated is a 0.5 cm asymmetry in the central left breast at posterior\ndepth, which was further evaluated with targeted ultrasound. Otherwise, there\nis no suspicious mass, unexplained architectural distortion, or suspicious\ngrouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area previously\nidentified mass.\n\nAt 6 o'clock, 4 cm from the nipple there is a 0.4 x 0.4 x 0.2 cm oval\ncircumscribed hypoechoic mass with no significant posterior features or\ninternal vascularity. Previously this measured 0.5 x 0.2 x 0.4 cm in\n___, which is stable, allowing for differences in measurement\ntechnique.", + "output": "A probably benign left breast mass demonstrates 6 months of stability.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and ultrasound in 6 months.\nAt that time, the patient will be due for ___ year follow-up of probably benign\nright breast masses, as well as the above described left breast mass.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRIGHT BREAST: A BB was placed in the right inferior and central/sub areolar\narea in the region of palpable mass as indicated by the patient. On ML 3D\ntomosynthesis views there is a high-density 1.0 x 1.2 cm mass, which was\nfurther evaluated on same day right breast ultrasound. Otherwise, there is no\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications. Patient has 2 biopsy clips, 1 coil clip in 1 ribbon clip\nin the right breast from prior benign ultrasound coarse.\n\nLEFT BREAST: The 5 mm focal asymmetry in the central left breast at posterior\ndepth is less dense compared to prior exam. Otherwise, there is no dominant\nmass, unexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed in\nthe areas of previously evaluated right breast mass as well as the area of\npalpable concern as indicated by the patient.\nA 0.4 x 0.3 x 0.5 cm heterogeneous, but predominantly hypoechoic\nwell-circumscribed mass at the 2 o'clock position 4 cm from nipple without\ndominant vascularity or posterior shadowing is again demonstrated and is\nstable/smaller compared to ___ exam where it measured 0.5 x 0.4 x\n0.5 cm.\n\nIn the area of patient's palpable lump, at the 6 o'clock position 0-1 cm from\nthe nipple, there is a dominant irregular hypoechoic vascular mass measuring\n1.3 x 0.9 x 1.2 cm, which extends into the overlying skin. In addition, there\nis irregularity along the lateral inferior aspect where there is extension to\na second irregular hypoechoic mass measuring 0.9 x 0.5 x 0.9 cm at the 7\no'clock position 1 cm from the nipple. The extent of both lesions in the\noblique plane spans approximately 2.7 cm.\n\nLEFT BREAST ULTRASOUND: Targeted left breast ultrasound was performed in the\narea of prior evaluation, at 6 o'clock 4 cm from the nipple, a 0.4 x 0.2 x 0.3\ncm well-circumscribed oval hypoechoic mass is seen, and previously measured\n0.5 x 0.2 x 0.4 cm on study of ___.", + "output": "1. Highly suspicious 1.3 cm mass in the right breast at 6 o'clock\ncorresponding to patient's palpable lump with extension in the lateral\ninferior breast to a second area, both together span 2.7 cm. Probable skin\ninvolvement of the 6 o'clock mass. Ultrasound-guided core biopsy is\nrecommended, if indicated, both lesions could be biopsied, the 6 o'clock and 7\no'clock components.\n2. Three year stability of a small benign-appearing 5 mm right breast mass,\nlikely corresponding to a complicated cyst. No further imaging follow-up is\nrecommended at this time.\n3. One year stability of a small probably benign left breast 4 mm mass. \nFollow-up ___ year diagnostic mammogram and ultrasound is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of 2 suspicious right breast\nmasses. Continued follow-up of a probably benign left breast mass with ___ year\ndiagnostic mammogram and ultrasound is recommended, unless her care team\ndecides Otherwise,.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nThe findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 1:15 pm, 5 minutes after\ndiscovery of the findings.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRIGHT BREAST: A BB was placed in the right inferior and central/sub areolar\narea in the region of palpable mass as indicated by the patient. On ML 3D\ntomosynthesis views there is a high-density 1.0 x 1.2 cm mass, which was\nfurther evaluated on same day right breast ultrasound. Otherwise, there is no\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications. Patient has 2 biopsy clips, 1 coil clip in 1 ribbon clip\nin the right breast from prior benign ultrasound coarse.\n\nLEFT BREAST: The 5 mm focal asymmetry in the central left breast at posterior\ndepth is less dense compared to prior exam. Otherwise, there is no dominant\nmass, unexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed in\nthe areas of previously evaluated right breast mass as well as the area of\npalpable concern as indicated by the patient.\nA 0.4 x 0.3 x 0.5 cm heterogeneous, but predominantly hypoechoic\nwell-circumscribed mass at the 2 o'clock position 4 cm from nipple without\ndominant vascularity or posterior shadowing is again demonstrated and is\nstable/smaller compared to ___ exam where it measured 0.5 x 0.4 x\n0.5 cm.\n\nIn the area of patient's palpable lump, at the 6 o'clock position 0-1 cm from\nthe nipple, there is a dominant irregular hypoechoic vascular mass measuring\n1.3 x 0.9 x 1.2 cm, which extends into the overlying skin. In addition, there\nis irregularity along the lateral inferior aspect where there is extension to\na second irregular hypoechoic mass measuring 0.9 x 0.5 x 0.9 cm at the 7\no'clock position 1 cm from the nipple. The extent of both lesions in the\noblique plane spans approximately 2.7 cm.\n\nLEFT BREAST ULTRASOUND: Targeted left breast ultrasound was performed in the\narea of prior evaluation, at 6 o'clock 4 cm from the nipple, a 0.4 x 0.2 x 0.3\ncm well-circumscribed oval hypoechoic mass is seen, and previously measured\n0.5 x 0.2 x 0.4 cm on study of ___.", + "output": "1. Highly suspicious 1.3 cm mass in the right breast at 6 o'clock\ncorresponding to patient's palpable lump with extension in the lateral\ninferior breast to a second area, both together span 2.7 cm. Probable skin\ninvolvement of the 6 o'clock mass. Ultrasound-guided core biopsy is\nrecommended, if indicated, both lesions could be biopsied, the 6 o'clock and 7\no'clock components.\n2. Three year stability of a small benign-appearing 5 mm right breast mass,\nlikely corresponding to a complicated cyst. No further imaging follow-up is\nrecommended at this time.\n3. One year stability of a small probably benign left breast 4 mm mass. \nFollow-up ___ year diagnostic mammogram and ultrasound is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of 2 suspicious right breast\nmasses. Continued follow-up of a probably benign left breast mass with ___ year\ndiagnostic mammogram and ultrasound is recommended, unless her care team\ndecides Otherwise,.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nThe findings were discussed with ___, N.P. by ___\n___, M.D. on the telephone on ___ at 1:15 pm, 5 minutes after\ndiscovery of the findings.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Magnified CC and ML views of the medial lower breast were initially obtained\nto evaluate for microcalcifications. These images demonstrate faint\ncalcifications posterior to the dominant mass which are concerning for\nadditional disease.\n\nUltrasound at ___ 1 cm from the nipple again identified an ill-defined\nirregular hypoechoic vascular mass measuring 2.5 x 0.9 x 1.6 cm which is in\ncontinuity with the second area at 7 o'clock with the overall area of\ninvolvement measuring 2.5 cm in maximal dimension. Given the continuity, it\nwas decided just to biopsy the dominant mass at 6 o'clock.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained, in the\npresence of a ___ interpreter.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___. ___, M.D. The procedure was supervised by P. ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle and 14-gauge Bard spring-loaded biopsy\ndevicewere used to obtain 4 cores. Next, a percutaneous CeleroMark dumbbell\nwas deployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. There are expected post biopsy changes with no significant\nhematoma.", + "output": "1. Technically successful US-guided core biopsy of the right breast mass at\n___ o'clock. If the biopsy proves to be malignant, consideration to imaging\nwith MRI should be considered to better delineate disease extent as the\nprimary mass is relatively occult on mammography.\n2. Faint calcifications in the right inferior and medial breast posterior to\nthe dominant mass. If the biopsy results prove malignant, bracketing of the\nmass and calcifications would be recommended.\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Magnified CC and ML views of the medial lower breast were initially obtained\nto evaluate for microcalcifications. These images demonstrate faint\ncalcifications posterior to the dominant mass which are concerning for\nadditional disease.\n\nUltrasound at ___ 1 cm from the nipple again identified an ill-defined\nirregular hypoechoic vascular mass measuring 2.5 x 0.9 x 1.6 cm which is in\ncontinuity with the second area at 7 o'clock with the overall area of\ninvolvement measuring 2.5 cm in maximal dimension. Given the continuity, it\nwas decided just to biopsy the dominant mass at 6 o'clock.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained, in the\npresence of a ___ interpreter.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___. ___, M.D. The procedure was supervised by P. ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle and 14-gauge Bard spring-loaded biopsy\ndevicewere used to obtain 4 cores. Next, a percutaneous CeleroMark dumbbell\nwas deployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. There are expected post biopsy changes with no significant\nhematoma.", + "output": "1. Technically successful US-guided core biopsy of the right breast mass at\n___ o'clock. If the biopsy proves to be malignant, consideration to imaging\nwith MRI should be considered to better delineate disease extent as the\nprimary mass is relatively occult on mammography.\n2. Faint calcifications in the right inferior and medial breast posterior to\nthe dominant mass. If the biopsy results prove malignant, bracketing of the\nmass and calcifications would be recommended.\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 31, 52, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 11 cm/sec.\nThe ICA/CCA ratio is 0.67.\nThe external carotid artery has peak systolic velocity of 66. Cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 55 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 25, 47, and 51 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 7 cm/sec.\nThe ICA/CCA ratio is 0.93.\nThe external carotid artery has peak systolic velocity of 60 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of hemodynamically significant stenosis in either carotid artery." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nmoderately dense fibroglandular tissue which somewhat lowers the sensitivity\nof mammography. A subtle area of distortion is seen in the upper outer left\nbreast which corresponds to the area of discomfort as indicated by the\npatient. This area was further evaluated with ultrasound. No dominant mass\nor suspicious clusters of microcalcifications are appreciated in either\nbreast.\n\nUltrasound of the left breast from ___ o'clock 1-10 cm from the nipple in the\narea of concern on mammography was performed. At ___ o'clock approximately 7\ncm from the nipple is identified a 3 cm heterogeneous area with decreased\nsound through transmission. This is felt to likely correspond to the\nmammographic finding and therefore ultrasound-guided core biopsy is\nrecommended at this time.", + "output": "Heterogeneous area in the left breast at ___ o'clock which is felt to likely\ncorrespond to a subtle area of distortion on mammography and also corresponds\nto the area of concern as indicated by the patient. Ultrasound-guided core\nbiopsy is recommended at this time. Depending upon the biopsy results,\nfurther imaging may be warranted.\n\nRECOMMENDATION: Left breast ultrasound-guided core biopsy.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. The\npatient scheduled the biopsy appointment upon leaving the department. An\nemail was also sent to Dr. ___ on ___ at 18:00 with these\nrecommendations.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "A 2.3 cm ill-defined heterogeneous area is identified ___ o'clock 7 cm from\nthe nipple in the left breast.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, M.D. N. ___, N.P.. The procedure was supervised by\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views shows clip placement at the\nlateral margin of the site of biopsy.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "A 2.3 cm ill-defined heterogeneous area is identified ___ o'clock 7 cm from\nthe nipple in the left breast.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, M.D. N. ___, N.P.. The procedure was supervised by\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views shows clip placement at the\nlateral margin of the site of biopsy.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nUnchanged area of heterogeneity in the upper outer quadrant of the left\nbreast. There is an associated biopsy clip. No architectural distortion is\nidentified on tomosynthesis images performed today. No dominant mass or\nsuspicious clusters of microcalcifications are appreciated in either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at the patient's\narea of concern demonstrated normal breast tissue (11 o'clock, 5-10 cm from\nthe nipple). Targeted ultrasound of the left breast demonstrate an unchanged\nheterogeneous area in the left breast at 1 o'clock, 7 cm from the nipple,\nwhich was previously biopsied.", + "output": "No evidence for malignancy. No mammographic or sonographic findings\ncorresponding to patient's area of pain in the right breast.\n\nRECOMMENDATION(S): A follow-up with the patient's primary care provider for\nsymptomatic management of right breast pain. Risk and age-appropriate\nscreening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nUnchanged area of heterogeneity in the upper outer quadrant of the left\nbreast. There is an associated biopsy clip. No architectural distortion is\nidentified on tomosynthesis images performed today. No dominant mass or\nsuspicious clusters of microcalcifications are appreciated in either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at the patient's\narea of concern demonstrated normal breast tissue (11 o'clock, 5-10 cm from\nthe nipple). Targeted ultrasound of the left breast demonstrate an unchanged\nheterogeneous area in the left breast at 1 o'clock, 7 cm from the nipple,\nwhich was previously biopsied.", + "output": "No evidence for malignancy. No mammographic or sonographic findings\ncorresponding to patient's area of pain in the right breast.\n\nRECOMMENDATION(S): A follow-up with the patient's primary care provider for\nsymptomatic management of right breast pain. Risk and age-appropriate\nscreening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\n\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 81 cm/s / 20 cm/s\nCCA Distal: 85 cm/s / 21 cm/s\nICA ___: 83 cm/s / 25 cm/s\nICA Mid: 96 cm/s / 30 cm/s\nICA Distal: 80 cm/s / 28 cm/s\nECA: 108 cm/s\nVertebral: 52 cm/s\n\nICA/CCA Ratio: 1.1\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\n\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 90 cm/s / 27 cm/s\nCCA Distal: 84 cm/s / 29 cm/s\nICA ___: 78 cm/s / 24 cm/s\nICA Mid: 80 cm/s / 27 cm/s\nICA Distal: 86 cm/s / 37 cm/s\nECA: 104 cm/s\nVertebral: 65 cm/s\n\nICA/CCA Ratio: 1.0\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. In discussion with Dr. ___ by Dr. ___ it was\ndecided to perform a diagnostic paracentesis and a therapeutic paracentesis of\n2 Liters. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2 L of clear, straw-colored fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, yielding 2 L of clear, straw-colored ascitic fluid. After\nfurther with attending Dr. ___ was consensus to perform a therapeutic\nparacentesis, in addition to diagnostic sampling, due to the amount of fluid\npresent." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nSpot-compression views show a persistent 5-6 mm focal asymmetry in the\nupper-outer right breast. There is no suspicious group of microcalcifications\nor architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper-outer right breast was\nperformed. In the right breast the 10 o'clock 8 cm from the nipple there is\nan irregular hypoechoic mass with ill-defined margins measuring 0.4 x 0.3 x\n0.5 cm, corresponding to the focal asymmetry. The mass demonstrates mild\nposterior acoustic shadowing. There is no definite internal vascularity. \nThere are no other cystic or solid masses seen in the upper-outer right breast\non ultrasound.\n\nTargeted ultrasound of the right axilla showed normal appearing lymph nodes.", + "output": "There is an indeterminate 5 mm mass at 10 o'clock 8 cm from the nipple in the\nright breast for which ultrasound-guided core biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the right breast mass.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. Findings and recommendations emailed to Dr. ___ by Dr. ___ on\n___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nSpot-compression views show a persistent 5-6 mm focal asymmetry in the\nupper-outer right breast. There is no suspicious group of microcalcifications\nor architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper-outer right breast was\nperformed. In the right breast the 10 o'clock 8 cm from the nipple there is\nan irregular hypoechoic mass with ill-defined margins measuring 0.4 x 0.3 x\n0.5 cm, corresponding to the focal asymmetry. The mass demonstrates mild\nposterior acoustic shadowing. There is no definite internal vascularity. \nThere are no other cystic or solid masses seen in the upper-outer right breast\non ultrasound.\n\nTargeted ultrasound of the right axilla showed normal appearing lymph nodes.", + "output": "There is an indeterminate 5 mm mass at 10 o'clock 8 cm from the nipple in the\nright breast for which ultrasound-guided core biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the right breast mass.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. Findings and recommendations emailed to Dr. ___ by Dr. ___ on\n___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the right breast at 10 o'clock 8 cm from the nipple is a 5 mm hypoechoic\nmass. This was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___. and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views show the clip placed with\nultrasound to be located in the upper outer breast. However, the location of\nthe clip does not correspond to the initially questioned mammographic\nasymmetry, confirming that the ultrasound and mammographic findings are not\ncorrelative.", + "output": "Technically successful US-guided core biopsy of 5 mm right breast 10 o'clock\nhypoechoic lesion. Pathology is pending.\n\nOn the post-procedure mammogram, it was confirmed that the area sampled with\nultrasound did not correspond to the mammographic abnormality.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient. \nFinal disposition of the mammographic asymmetry will be dependent on pathology\nresults of the ultrasound biopsy.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast at 10 o'clock 8 cm from the nipple is a 5 mm hypoechoic\nmass. This was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___. and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views show the clip placed with\nultrasound to be located in the upper outer breast. However, the location of\nthe clip does not correspond to the initially questioned mammographic\nasymmetry, confirming that the ultrasound and mammographic findings are not\ncorrelative.", + "output": "Technically successful US-guided core biopsy of 5 mm right breast 10 o'clock\nhypoechoic lesion. Pathology is pending.\n\nOn the post-procedure mammogram, it was confirmed that the area sampled with\nultrasound did not correspond to the mammographic abnormality.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient. \nFinal disposition of the mammographic asymmetry will be dependent on pathology\nresults of the ultrasound biopsy.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted grayscale ultrasound images were obtained of the 4 quadrants of the\nabdomen, revealing no ascitesthe right upper, right lower, left lower, and\nleft upper quadrants.", + "output": "No ascites within the 4 quadrants of the abdomen." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 93 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 98, 70, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 117 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 155, 70, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.5..\nThe external carotid artery has peak systolic velocity of 128 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the right internal carotid artery. 60-69% stenosis\nof the left internal carotid artery." + }, + { + "input": "Ultrasound guidance for transrectal prostate biopsy was attempted, however due\nto technical malfunction with the ultrasound machine, adequate images of the\nprostate could not be obtained. The patient will not be charged for\nultrasound guidance during this procedure.", + "output": "Attempted ultrasound guidance for prostate biopsy by Dr. ___. Due to\ntechnical malfunction with the ultrasound machine, adequate images of the\nprostate could not be obtained." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 20 cc of yellow fluid were removed. Fluid samples were\nsubmitted to the laboratory for chemistry, cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 20 cc of fluid were removed." + }, + { + "input": "The aorta measures 2.0 x 2.1 cm in the proximal portion, 1.5 x 1.5 cm in mid\nportion and 1.4 x 1.4 cm in the distal abdominal aorta. There is mild\ncalcified atherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.9 x 0.9 cm and the left common iliac\nartery measures 1.0 x 1.0 cm.\n\nThe right kidney measures 12.4 cm and the left kidney measures 12.4 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.7 L of amber fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right upper quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 4.5 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.8 L of straw-colored fluid were removed.\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Successful ultrasound-guided paracentesis, without acute complication.\n2. 3.8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.6 L of straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.85 L of blood stained fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Ultrasound guided therapeutic paracentesis\n2. 4.85 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.8 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.8 L of fluid were removed." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 5 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 2% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Pain control was provided by administering divided doses of\nfentanyl throughout the total intra-service time of 15 minutes during which\npatient's hemodynamic parameters were continuously monitored by an independent\ntrained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 38, 42, and 59 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 19\ncm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 64 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 43, 61, and 76 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 22\ncm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 70 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower and 4.3 L of clear, straw-colored fluid was removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis. 4.3 L of clear straw-colored fluid was removed and samples were\nsubmitted to the laboratory for cell count, differential, and culture." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAt the 7 to 8:00 position right breast posterior depth there is a 2.8 x 1.6 x\n1.9 cm lobulated mass which likely corresponds to palpable abnormality within\nthe right breast. A biopsy clip is noted centrally within this mass\nconsistent with patient's biopsy proven fibroadenoma. At the approximately\n6:00 position right breast posterior depth there is a 1.3 x 1.1 x 1.1 cm\npartially obscured round mass. In the right central breast at mid depth there\nis an asymmetry best seen on MLO tomosynthesis image 11 and lateral\ntomosynthesis image 13. There is no architectural distortion or suspicious\ngrouped microcalcifications.\n\nBREAST ULTRASOUND: At the 7:00 position right breast 4 cm from the nipple\nthere is a single lobulated oval mass with parallel orientation measuring\napproximately 2.4 x 0.8 x 2.0 cm which is slightly larger when compared to\npatient's prior ultrasounds from ___ where it measured 2.0 x 0.6 x 1.7 cm. \nThe extent of this mass is best visualized on the cine images. Biopsy clip is\nlocated centrally consistent with biopsy-proven fibroadenoma.\n\nAt the 6 o'clock position right breast 2 cm from the nipple there is a 1.5 x\n0.6 x 1.2 cm circumscribed oval hypoechoic mass with parallel orientation,\nposterior acoustic enhancement and no significant internal color flow\ncorresponding to mass seen on mammogram.\n\nAt the 12:00 position right breast 4 cm from the nipple there is a 0.8 x 0.6 x\n0.7 cm circumscribed oval to slightly lobulated hypoechoic mass with parallel\norientation, posterior acoustic enhancement, and no significant internal color\nflow corresponding to asymmetry seen on mammogram.", + "output": "Slight interval enlargement of previously biopsied fibroadenoma at the 7:00\nposition right breast currently measuring 2.4 x 0.8 x 2.0 cm which previously\nmeasured 2.0 x 0.6 x 1.7 cm in ___ which is not unexpected. Clinical\nfollow-up of this mass is recommended.\n\nSimilar appearing 1.5 cm mass at the 6 o'clock position right breast and 0.8\ncm mass at the 12:00 position right breast also likely represent benign\nfibroadenomas. Six-month follow-up ultrasound of these masses is recommended\nto ensure stability.\n\nRECOMMENDATION(S): Six-month follow-up diagnostic ultrasounds of the right\nbreast.\n\nClinical follow-up biopsy-proven fibroadenoma right breast which has\ndemonstrated slight interval enlargement over the course ___ years.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up. \nThe patient was also given information for the Breast Care Center should she\ndesire surgical excision of the previously biopsied fibroadenoma.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the right breast at the 6 o'clock position, 2 cm from the nipple, again\nseen is a 1.5 x 0.7 x 1.3 cm oval, circumscribed hypoechoic, avascular mass,\nwith increased through transmission, without appreciable change from prior.\n\nIn the right breast at the 12 o'clock position, 4 cm from the nipple, there is\na similar-appearing 0.9 x 0.5 x 0.7 cm oval, circumscribed hypoechoic,\navascular mass, also unchanged.", + "output": "Two (2) stable probably benign right breast masses measuring 1.5 cm and 0.9\ncm, at the 6 o'clock and 12 positions, respectively, as detailed above. \nContinued follow-up is recommended.\n\nRECOMMENDATION(S): Six-month follow-up diagnostic right breast ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the 6 o'clock position, 2 cm from the nipple, there is a 1.7 cm homogeneous\nwell-defined oval-shaped solid nodule measuring 1.7 cm in maximum dimension,\npreviously measuring 1.5 cm.\n\nIn the 12:00 o'clock region, 4 cm from nipple, there is a homogeneous\nwell-defined oval-shaped solid nodule measuring 0.9 cm in maximum dimension,\npreviously measuring 0.7 cm.\n\nNo additional focal abnormality identified.", + "output": "Probably benign assessment. 2 solid nodules, minimally increased in size,\nmost consistent with benign fibroadenomas, and slightly increased in size\nlikely due to patient's current pregnancy.\n\nRECOMMENDATION(S): Recommend additional 6 month follow-up right breast\nultrasound to confirm stability of these 2 solid nodules.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS 3\n\n BI-RADS: 3 Probably Benign." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nRight T6 radicular artery: No evidence of AV shunting\n\nRight T7 radicular artery: No evidence of AV shunting\n\nRight T8 radicular artery : No evidence of AV shunting\n\nLeft T8 radicular artery : No evidence of AV shunting\n\nLeft T7 radicular artery : No evidence of AV shunting\n\nLeft T6 radicular artery : No evidence of AV shunting\n\nRight T9 radicular artery : No evidence of AV shunting\n\nRight T10 radicular artery : No evidence of AV shunting. The artery of\n___ arises from this level.\n\nLeft T10 radicular artery : No evidence of AV shunting\n\nLeft T9 radicular artery : No evidence of AV shunting\n\nRight T11 radicular artery : No evidence of AV shunting\n\nLeft T11 radicular artery : No evidence of AV shunting\n\nRight T12 radicular artery : No evidence of AV shunting\n\nAortogram investigating the bilateral T12, L1, and L2 radicular arteries : No\nevidence of AV shunting. Also opacification of the bilateral renal arteries.\n\nAortogram 2 investigating the L 2, L3 and L4 radicular arteries : No evidence\nof AV shunting\n\nAortogram 3 investigating the bilateral iliac and L5 radicular arteries as\nwell as the iliacs and sacral vasculature : No evidence of AV shunting\n\nRight subclavian artery : No evidence of AV shunting. There is opacification\nof internal mamillary artery as well as the vertebral artery in the\nthyrocervical trunk. There is no evidence of AV shunting. There is reflux\ninto the innominate artery and pale opacification of the right common carotid\nartery.\n\nLeft subclavian artery : No evidence of AV shunting. Opacification of the\ninternal mamillary artery as well as the vertebral artery and thyrocervical\ntrunk.", + "output": "No evidence of AV shunting. Normal spinal angiogram.\n\nRECOMMENDATION(S): Plan per neurology" + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are no suspicious microcalcifications, spiculated masses or areas of\ndistortion in the right breast.\n\nOn the initial images, there is an ill-defined focal asymmetry or obscured\nmass in central slightly upper and outer left breast. Spot compression\ntomosynthesis views show that an ill-defined mass persists with indistinct or\nspiculated margins and associated architectural changes. Although the margins\nare ill-defined, the abnormality is at least 2.5 cm. There are no associated\nsuspicious calcifications.\n\nBREAST ULTRASOUND: Focused ultrasound of the outer breast was performed in\nthe area of the mammographic abnormality and the palpable finding. This\ncorresponds to an irregular hypoechoic mass with indistinct and angulated\nmargins and some posterior shadowing in the 3 o'clock position of the left\nbreast 2 cm from the nipple. Internal vascularity is documented. The long\naxis is parallel to the chest wall. There is architectural change in the\nsurrounding tissues and a suggestion of possible duct extension at one pole. \nSonographically it measures at least 2.3 x 1.2 x 2.2 cm.\n\nUltrasound evaluation of the left axilla shows an abnormal lymph known with\nfocal nodular thickening at 1 pole. The lymph node measures 1.5 cm in long\naxis however the focal cortical thickening forms a mass measuring 0.5 x 1.1 x\n0.6 cm. Additional morphologically normal lymph nodes are seen nearby.", + "output": "There is a palpable solid mass in the left breast at 3 o'clock 2 cm from the\nnipple with suspicious mammographic and sonographic features. Additionally,\nthere is a left axillary lymph node identified with focal nodular cortical\nthickening.\n\nNo specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy with clip placement of the\nsuspicious mass in the 3 o'clock position of the left breast is recommended. \nFine-needle aspiration biopsy or core biopsy of the abnormal left axillary\nlymph node is also recommended.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient and with her daughter who provided interpretation, and both agree with\nthis plan. She was given information to schedule her biopsy. The results and\nrecommendations were called to Dr. ___ and were discussed with nurse\n___ at 17:10. Dr. ___ will provide scheduling support and\nclinical follow-up.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "There is a 2.1 cm irregular, hypoechoic mass at the 3 o'clock position of the\nleft breast with an abnormal left axillary lymph node with a focal cortical\nbulge.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nClinicians: ___. ___ M.D.. The procedure was supervised by ___,\nM.D.(Attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and 5 cores were\nobtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nAXILLARY LYMPH NODE FNA: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, fine needle aspiration of the abnormal left axillary lymph\nnode was performed. A total of 3 passes were made. The needle was removed\nand hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Breast samples sent to pathology and lymph node samples sent to\ncytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the left breast mass.", + "output": "Technically successful US-guided core biopsy of left breast mass and fine\nneedle aspiration left axillary lymph node. Pathology and FNA are pending.\n\nThe patient expects to hear the pathology results from referring clinician Dr.\n___ in ___ business days. Standard post care instructions were provided to\nthe patient." + }, + { + "input": "There is a 2.1 cm irregular, hypoechoic mass at the 3 o'clock position of the\nleft breast with an abnormal left axillary lymph node with a focal cortical\nbulge.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nClinicians: ___. ___ M.D.. The procedure was supervised by ___,\nM.D.(Attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and 5 cores were\nobtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nAXILLARY LYMPH NODE FNA: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, fine needle aspiration of the abnormal left axillary lymph\nnode was performed. A total of 3 passes were made. The needle was removed\nand hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Breast samples sent to pathology and lymph node samples sent to\ncytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the left breast mass.", + "output": "Technically successful US-guided core biopsy of left breast mass and fine\nneedle aspiration left axillary lymph node. Pathology and FNA are pending.\n\nThe patient expects to hear the pathology results from referring clinician Dr.\n___ in ___ business days. Standard post care instructions were provided to\nthe patient." + }, + { + "input": "Enlarged left axillary lymph node was identified, measuring 1 x 0.7 x 0.7 cm,\nwhich has been previously sampled by fine needle aspiration. This was\ntargeted for clip placement.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained with the\nassistance of an interpreter.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised\nby ___. ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided HydroMARK clip placement in the enlarged left\naxillary lymph node.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a clip in the left upper outer mid depth breast, from prior core\nbiopsy-proven cancer. The density in this region has decreased since the\nprior exam. This area was further assessed with ultrasound. No new mass is\nseen. There are no suspicious grouped calcifications. There is no\nunexplained architectural distortion. Left axillary lymph nodes are not\nimaged on this mammogram.\n\nTargeted ultrasound of the left breast 3 o'clock region was performed with\nattention to the area of core biopsy-proven invasive ductal cancer. The\nribbon clip is identified. A discrete hypoechoic mass is not seen today. \nThere is some distortion of the tissues and subtle decreased echogenicity\naround the clip, likely related to prior mass. This area measures\napproximately 1.2 x 1.3 x 0.4 cm. This does not have increased internal\nvascularity.\n\nTargeted ultrasound of the right axilla was performed, with specific attention\nto the lymph node which was sampled previously and contains a HydroMARK clip. \nThe lymph node has decreased in size, now measuring 7 x 4 x 7 mm. Other\nsonographically normal appearing lymph nodes are seen in the left axilla.", + "output": "Imaging appearance of the mass and axillary lymph node have improved since\n___, consistent with positive response to neoadjuvant chemotherapy.\n\nRECOMMENDATION(S): Patient, via interpreter, reports continued chemotherapy\ntreatments. Recommend clinical follow-up with imaging follow-up as clinically\nwarranted based on treatment plan.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study with an interpreter. She agrees with the plan.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a clip in the left upper outer mid depth breast, from prior core\nbiopsy-proven cancer. The density in this region has decreased since the\nprior exam. This area was further assessed with ultrasound. No new mass is\nseen. There are no suspicious grouped calcifications. There is no\nunexplained architectural distortion. Left axillary lymph nodes are not\nimaged on this mammogram.\n\nTargeted ultrasound of the left breast 3 o'clock region was performed with\nattention to the area of core biopsy-proven invasive ductal cancer. The\nribbon clip is identified. A discrete hypoechoic mass is not seen today. \nThere is some distortion of the tissues and subtle decreased echogenicity\naround the clip, likely related to prior mass. This area measures\napproximately 1.2 x 1.3 x 0.4 cm. This does not have increased internal\nvascularity.\n\nTargeted ultrasound of the right axilla was performed, with specific attention\nto the lymph node which was sampled previously and contains a HydroMARK clip. \nThe lymph node has decreased in size, now measuring 7 x 4 x 7 mm. Other\nsonographically normal appearing lymph nodes are seen in the left axilla.", + "output": "Imaging appearance of the mass and axillary lymph node have improved since\n___, consistent with positive response to neoadjuvant chemotherapy.\n\nRECOMMENDATION(S): Patient, via interpreter, reports continued chemotherapy\ntreatments. Recommend clinical follow-up with imaging follow-up as clinically\nwarranted based on treatment plan.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study with an interpreter. She agrees with the plan.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 69.2 cm/s / 15.2 cm/s\nCCA Distal: 55.7 cm/s / 13.5 cm/s\nICA ___: 70.9 cm/s / 11.1 cm/s\nICA Mid: 49.2 cm/s / 13.5 cm/s\nICA Distal: 52.2 cm/s / 18.8 cm/s\nECA: 77.3 cm/s\nVertebral: 46.3 cm/s\n\nICA/CCA Ratio: 1.27\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 104 cm/s / 13.5 cm/s\nCCA Distal: 69.8 cm/s / 17 cm/s\nICA ___: 40.5 cm/s / 8.3 cm/s\nICA Mid: 77.4 cm/s / 16.4 cm/s\nICA Distal: 56.6 cm/s / 14.1 cm/s\nECA: 54.7 cm/s\nVertebral: 40.1 cm/s\n\n\nICA/CCA Ratio: 1.11\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Targeted sonographic evaluation of the right lung base shows a small right\npleural effusion with scattered internal echoes, suggestive of complex fluid. \nThis region was targeted for ultrasound-guided drainage catheter placement,\nyielding 35 cc of hemorrhagic fluid during the procedure.", + "output": "Successful US-guided placement of ___ pigtail catheter into the loculated\nright hemothorax, which was attached to a Pleur-Evac." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in segment ___. A suitable\napproach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, two 18-gauge core biopsy passes were\nmade. The sample was provided to the on-site cytologist who indicated an\nadequate sample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n0.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n20 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted biopsy x 2 of a lesion in the left lobe of the\nliver, with specimen sent to pathology." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe right breast demonstrates a 1.0 x 1.0 x 1.5 cm area of architectural\ndistortion in the slightly upper outer quadrant at middle depth which is less\napparent on spot compression views. There are no associated calcifications. \nThere is some mild nipple retraction noted. The remainder of the right breast\nis without suspicious dominant mass or grouped calcifications. There is no\nabnormality in the medial right breast near the marker.\n\nThe left breast demonstrates a 3.5 x 2.5 x 2.6 cm irregular spiculated mass in\nthe slightly upper outer quadrant at middle depth which persists on spot\ncompression views, and is without associated microcalcifications. No other\nmasses are seen in the left breast.\n\nBILATERAL BREAST ULTRASOUND:\nRight: Targeted ultrasound of the right upper outer quadrant was performed, at\nthe patient's area of clinical concern and also at the area of mammographic\nconcern. Targeted ultrasound of the right medial breast was also performed.\nIn the right upper outer quadrant at 9 through 12 o'clock 0-12 cm from the\nnipple there is no discrete abnormality identified. There is some prominent\nvascular flow seen at 10 o'clock 3 cm from the nipple which may be at the\nlocation of the mammographic finding. There is no abnormality in the medial\nright breast at the patient's clinical area of concern from 04:00.\n\nLeft: Targeted ultrasound of the left upper outer quadrant at ___ o'clock 2-4\ncm from the nipple demonstrates a 3.2 x 1.9 x 2.8 cm irregular spiculated\nhypoechoic mass with dominant vascularity and marked posterior shadowing,\nwhich corresponds to the mammographic finding. This finding is highly\nsuspicious for malignancy.\nScanning of the left axilla demonstrates normal appearance of axillary lymph\nnodes.", + "output": "Highly suspicious 3.2 cm left breast mass ___ o'clock 2-4 cm from the nipple. \nThis mass is also palpable. Ultrasound-guided core biopsy with clip placement\nis recommended.\nNo definite left axillary adenopathy.\nSubtle distortion seen in the right breast upper outer quadrant on\nmammography, without a discrete ultrasound correlate, for which additional\nevaluation with either contrast mammography or MRI is recommended, once left\nbreast pathology is obtained.\n\nRECOMMENDATION(S): Left ultrasound-guided core biopsy with clip placement.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given a biopsy appointment on ___ at 2:15 pm, at ___ along with a ___ interpreter. Her clinician has\nbeen contacted for appropriate orders which are in OMR.\nThe patient was previously on aspirin but has not taken any lately.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Targeted ultrasound of the left breast was performed. As seen on the prior\nultrasound and mammogram from ___, there is a 2.8 x 2.7 x 3.0 cm\nirregular spiculated mass at 1 o'clock approximately 2 cm from the nipple.\n\nTargeted ultrasound of the left axilla revealed normal appearing lymph nodes.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. and ___, M.D.. The procedure was supervised\nby ___, M.D. (attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: Deferred at the patient's request.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has trace calcified atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 55, 79, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 0.93.\nThe external carotid artery has peak systolic velocity of 89 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has trace calcified atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 66, 81, and 74 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.07.\nThe external carotid artery has peak systolic velocity of 114 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis bilaterally. Trace calcified plaque\nbilaterally." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is an approximately 5-6 mm asymmetry in the posterior central right\nbreast, which is pliable and changeable on multiple images, suggesting a\nbenign cause, such as overlapping breast tissue. There is no associated\ndistortion or calcifications. There are no suspicious grouped calcifications,\narchitectural distortion or definite mass in the right breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the entire central right breast\nfrom ___ and from ___ o'clock positions including upper and lower right\nbreast was performed. There are no suspicious solid or cystic masses seen.", + "output": "There is a probably benign 5-6 mm asymmetry in the posterior central right\nbreast, without sonographic correlate.\n\nRECOMMENDATION(S): Short-term interval followup with a diagnostic mammogram\nin 6 months to document stability is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "There is a 3.3 x 0.8 x 1.0 cm ___ cyst, and typical location\nbetween the medial gastrocnemius and semimembranosus, with a few septations\nand non hyperemic synovial thickening, similar to previous.", + "output": "Uneventful ultrasound-guided aspiration and injection of long-acting\nanesthetic and steroid into the left knee ___ cyst.\n\n\nI Dr. ___ personally supervised the Resident/Fellow during the key\ncomponents of the above procedure and I have reviewed and agree with the\nResident/Fellow findings/dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 84, 70, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 129 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 85 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 79, 78, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 0.95.\nThe external carotid artery has peak systolic velocity of 137 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild atherosclerotic plaque in the bilateral carotid arteries without\nhemodynamically significant stenosis." + }, + { + "input": "Mammogram:\n\nTissue density: There are scattered areas of fibroglandular density.\n\n\nRight breast: Additional views confirm the presence of 1 cm and smaller\ncircumscribed equal density oval masses in the lower slightly outer anterior\nright breast.\n\nTwo focal asymmetries measuring 10 and 8 mm in the upper inner left breast\nalso persist on additional views. There are no suspicious calcifications\nassociated with the masses or the asymmetries. Again noted is a 13 mm\nlobulated equal density mass with a central popcorn type calcification located\nin the upper-outer right breast, consistent with a degenerating fibroadenoma.\n\nLeft breast: Focal asymmetries in the lower inner and upper outer left breast\npersist on additional views. There are no associated calcifications, or areas\nof architectural distortion.\n\nBREAST ULTRASOUND:\n\nRight breast: Targeted ultrasound of the lower slightly outer right breast\nwas performed. In the 7 o'clock position approximately 3 cm from the nipple\nthere is a 7 x 5 mm round anechoic circumscribed mass. Immediately lateral to\nthis mass there is a second oval parallel circumscribed hypoechoic mass\nmeasuring 7 x 3 mm.\nAdditionally, at 7 o'clock approximately 4 cm from the nipple there is a\nreniform hypoechoic 6 mm mass with a fatty hilum, consistent with a normal\nintramammary lymph node.\n\nIn the ___ o'clock position approximately 8-9 cm from the nipple there is a\nhypoechoic lobulated circumscribed mass measuring 11 x 7 mm mm, containing\ncentral bright echogenic reflector, consistent with a mammographic lobulated\nmass with central popcorn calcification.\n\n\nLeft breast: ultrasound of the entire left breast was performed. There are no\nsuspicious solid or cystic lesions identified. There are no definite\nsonographic correlates to the mammographic asymmetries.", + "output": "There are probably benign masses in the lower outer and upper inner right\nbreast and focal asymmetries in the lower inner and upper outer left breast\n\nRECOMMENDATION: Short-term interval followup with bilateral diagnostic\nmammograms recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Mammogram:\n\nTissue density: There are scattered areas of fibroglandular density.\n\n\nRight breast: Additional views confirm the presence of 1 cm and smaller\ncircumscribed equal density oval masses in the lower slightly outer anterior\nright breast.\n\nTwo focal asymmetries measuring 10 and 8 mm in the upper inner left breast\nalso persist on additional views. There are no suspicious calcifications\nassociated with the masses or the asymmetries. Again noted is a 13 mm\nlobulated equal density mass with a central popcorn type calcification located\nin the upper-outer right breast, consistent with a degenerating fibroadenoma.\n\nLeft breast: Focal asymmetries in the lower inner and upper outer left breast\npersist on additional views. There are no associated calcifications, or areas\nof architectural distortion.\n\nBREAST ULTRASOUND:\n\nRight breast: Targeted ultrasound of the lower slightly outer right breast\nwas performed. In the 7 o'clock position approximately 3 cm from the nipple\nthere is a 7 x 5 mm round anechoic circumscribed mass. Immediately lateral to\nthis mass there is a second oval parallel circumscribed hypoechoic mass\nmeasuring 7 x 3 mm.\nAdditionally, at 7 o'clock approximately 4 cm from the nipple there is a\nreniform hypoechoic 6 mm mass with a fatty hilum, consistent with a normal\nintramammary lymph node.\n\nIn the ___ o'clock position approximately 8-9 cm from the nipple there is a\nhypoechoic lobulated circumscribed mass measuring 11 x 7 mm mm, containing\ncentral bright echogenic reflector, consistent with a mammographic lobulated\nmass with central popcorn calcification.\n\n\nLeft breast: ultrasound of the entire left breast was performed. There are no\nsuspicious solid or cystic lesions identified. There are no definite\nsonographic correlates to the mammographic asymmetries.", + "output": "There are probably benign masses in the lower outer and upper inner right\nbreast and focal asymmetries in the lower inner and upper outer left breast\n\nRECOMMENDATION: Short-term interval followup with bilateral diagnostic\nmammograms recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Transrectal ultrasound revealed a right hypoechoic intraprostatic collection,\nmeasuring approximately 1.8 x 1.6 cm, targeted for transrectal\nultrasound-guided aspiration. 3 cc of purulent fluid was aspirated, with the\nsample sent for microbiology evaluation. Post procedural transrectal\nultrasound images revealed near-complete collapse of the collection.", + "output": "Successful US-guided prostate collection aspiration. Sample was sent for\nmicrobiology evaluation." + }, + { + "input": "The left inferior anterior chest wall, there was a 1.4 x 5.1 cm hypoechoic\ncollection in the deep subcutaneous tissue. In the left more superior\nanterior chest wall at the second site of aspiration, there is an 7.3 x 1.8 cm\nhypoechoic collection.", + "output": "Aspiration of up to 5cc of serosanguinous fluid of a subcutaneous anterior\nchest wall collection. Remaining collections were not drainable, possibly\nrepresenting old hematoma.\n\nRECOMMENDATION(S): Given the deep location of the collections and difficulty\nwith visualization on US, if swelling worsens consider next evaluation with\nCT." + }, + { + "input": "A focused ultrasound examination of the right supraclavicular region\ndemonstrates a 6 mm lymph node which appears round, with loss of the normal\nfatty hilum (series 1, image 4). Several tiny arteries course anteriorly to\nthis node, within the strap muscles. There is no fluid collection.", + "output": "Abnormal-appearing right supraclavicular lymph node is suspicious for\nmetastasis in the setting of known metastatic pancreatic cancer.\n\nAt the time of this examination, the patient's INR was 3.4, precluding any\nability to perform a core biopsy today. As discussed by Dr. ___ with Dr.\n___ was felt that time that an FNA would unlikely yield enough\ndiagnostic information to affect Mr ___ clinical management. The decision\nwas made to place his Coumadin on hold, with the plan for a core biopsy once\nthe INR falls below 2.0." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated noascites. A\nsuitable target in the deepest pocket in the right lower quadrant was selected\nfor paracentesis.\n\nPROCEDURE: Paracentesis was not performed as there was no suitable target.", + "output": "No suitable pocket of ascites to target for paracentesis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.5 L of chylous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.3 L of white chylous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.3 L of white chylous fluid were removed." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nLEFT: Postoperative changes are seen in the left breast including\narchitectural distortion and clips. In the outer central left breast, there\nis re-demonstration of a well-circumscribed 0.9 cm isodense oval mass, not\nsignificantly changed compared to prior mammogram dated ___,\nconsistent with an intramammary lymph node. An adjacent similar appearing 0.6\ncm well-circumscribed oval mass is also noted, in the upper outer quadrant of\nthe left breast. There is no unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nRIGHT: There is no dominant mass, architectural distortion, or suspicious\ngrouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed over the left breast\nfrom 12 o'clock to 4 o'clock. At 3 o'clock 8 cm from the nipple, there is a\nnormal appearing 7 mm lymph node with normal cortical thickness. More\nsuperiorly at approximately ___ o'clock, 8 cm from the nipple, a normal\nappearing 5 mm lymph node is identified. These correspond to the mammographic\nfindings described above.", + "output": "1. Two masses seen in the left breast which correspond to benign intramammary\nlymph nodes on ultrasound evaluation. No specific mammogram or ultrasound\nevidence for malignancy.\n2. No specific evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): ___ year diagnostic mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nLEFT: Postoperative changes are seen in the left breast including\narchitectural distortion and clips. In the outer central left breast, there\nis re-demonstration of a well-circumscribed 0.9 cm isodense oval mass, not\nsignificantly changed compared to prior mammogram dated ___,\nconsistent with an intramammary lymph node. An adjacent similar appearing 0.6\ncm well-circumscribed oval mass is also noted, in the upper outer quadrant of\nthe left breast. There is no unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nRIGHT: There is no dominant mass, architectural distortion, or suspicious\ngrouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed over the left breast\nfrom 12 o'clock to 4 o'clock. At 3 o'clock 8 cm from the nipple, there is a\nnormal appearing 7 mm lymph node with normal cortical thickness. More\nsuperiorly at approximately ___ o'clock, 8 cm from the nipple, a normal\nappearing 5 mm lymph node is identified. These correspond to the mammographic\nfindings described above.", + "output": "1. Two masses seen in the left breast which correspond to benign intramammary\nlymph nodes on ultrasound evaluation. No specific mammogram or ultrasound\nevidence for malignancy.\n2. No specific evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): ___ year diagnostic mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Large masses/lymph nodes are seen in the left axilla. The largest one was\ntargeted for biopsy.", + "output": "Successful ultrasound-guided biopsy of a left axillary mass, with 2 core\nbiopsy specimens sent for pathology. No immediate postprocedural\ncomplications." + }, + { + "input": "RIGHT:\nThere is no atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 70.8 cm/s / 15.7 cm/s\nCCA Distal: 67.7 cm/s / 15 cm/s\nICA ___: 57.7 cm/s / 13.3 cm/s\nICA Mid: 49.9 cm/s / 14.9 cm/s\nICA Distal: 61.1 cm/s / 19.3 cm/s\nECA: 59.3 cm/s\nVertebral: 30.2 cm/s\n\nICA/CCA Ratio: 0.9\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 65.2 cm/s / 13.4 cm/s\nCCA Distal: 68.2 cm/s / 13.6 cm/s\nICA ___: 56 cm/s / 14.6 cm/s\nICA Mid: 72.7 cm/s / 17.6 cm/s\nICA Distal: 71.6 cm/s / 21.5 cm/s\nECA: 66.8 cm/s\nVertebral: 33.7 cm/s\n\nICA/CCA Ratio: 1.07\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA: No stenosis.\nLeft ICA: <40% stenosis." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThe questioned asymmetry in the inner breast middle depth seen on CC\nprojection was not reproduced on additional imaging and is consistent with\nsuperimposed fibroglandular tissue.\n\nThe questioned asymmetry in the central breast middle depth on MLO projection\nappears pliable on spot compression images compatible with superimposed\nfibroglandular tissue. This area was further evaluated by ultrasound\ndemonstrating no suspicious mass or significant ultrasound correlate.\n\nThe questioned rounded asymmetry in the right nipple was not reproduced on\nadditional imaging. When discussed with the patient, patient noted to have an\nepisode of non spontaneous non-bloody clear nipple discharge upon compression\non prior screening mammogram.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted right breast ultrasound was performed.\n\nThe inner right breast was scanned from 2 o'clock through 4 o'clock, 0-5 cm\nfrom the nipple demonstrating no suspicious mass or significant ultrasound\ncorrelate corresponding to the questioned right breast asymmetry.\n\nThe retroareolar breast was also scanned demonstrating multiple nondilated\nretroareolar ducts without a discrete suspicious solid, cystic, or intraductal\nmass.", + "output": "1. No specific evidence of malignancy in the right breast. The questioned\nright breast focal asymmetry is most compatible with superimposed normal\nbreast tissue.\n2. The questioned right breast nipple asymmetry was not reproduced on today's\nexamination and may have represented nipple discharge which was expressed at\nthe time of screening examination. Continued clinical follow-up is\nrecommended.\n\nRECOMMENDATION(S): Age-appropriate risk screening. Continued clinical\nfollow-up of right breast non spontaneous nipple discharge.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Patent left lower extremity femoral -below the knee popliteal at with\ntriphasic Doppler waveforms throughout.\n\nPeak systolic velocities are as follows:\nNative vessel proximal: 142 cm/second.\nNative vessel distal: 88 cm/sec, biphasic waveform.\nAnastomosis proximal: 107 cm/second\nAnastomosis distal: 140 cm/second.\n\nIntragraft velocities range from 95 through 140 cm/second.", + "output": "No evidence of bypass graft stenosis." + }, + { + "input": "Targeted ultrasound of the left axilla was performed in the area of clinical\nconcern. There is a 1.1 x 0.6 x 1.1 cm hypoechoic subdermal irregular mass,\nsuggesting a complicated fluid collection containing echogenic material with\nsurrounding marked vascularity. There is a suggestion of a skin tract to the\ncollection. On physical examination, there is a skin punctum.", + "output": "Patient's palpable abnormality in the left axilla corresponds to a 1.1 cm\nhypoechoic mass with the appearance suggestive of an inflamed sebaceous cyst.\n\nRECOMMENDATION: Given patient's history of breast cancer, clinical of\nevaluation by the breast Care Center is recommended. Short-term ultrasound\nfollowup is recommended in the absence of clinical improvement.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Findings and recommendations discussed with ___ NP at\n16:55 ___ and Dr. ___ at 17:05 ___ by phone.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA BB marker is placed at the central to slightly upper, inner right breast at\nsite of palpable abnormality as indicated by the patient. There is no\nspiculated mass, suspicious grouped microcalcifications or unexplained\narchitectural distortion in either breast.\n\nRIGHT BREAST ULTRASOUND: Ultrasound of the right breast from ___ 1-8 cm\nfrom the nipple in the area of concern as indicated by the patient and\nreferring physician was performed. No solid suspicious mass or cystic lesion\nis seen. Any decision to biopsy at this time should be based on the clinical\nassessment.", + "output": "No focal mammographic or sonographic abnormality identified in the right\nbreast in an area of concern as indicated by the patient and referring\nphysician. Any decision to biopsy at this time should be based on the\nclinical assessment.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her annual\nmammogram.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA BB marker is placed at the central to slightly upper, inner right breast at\nsite of palpable abnormality as indicated by the patient. There is no\nspiculated mass, suspicious grouped microcalcifications or unexplained\narchitectural distortion in either breast.\n\nRIGHT BREAST ULTRASOUND: Ultrasound of the right breast from ___ 1-8 cm\nfrom the nipple in the area of concern as indicated by the patient and\nreferring physician was performed. No solid suspicious mass or cystic lesion\nis seen. Any decision to biopsy at this time should be based on the clinical\nassessment.", + "output": "No focal mammographic or sonographic abnormality identified in the right\nbreast in an area of concern as indicated by the patient and referring\nphysician. Any decision to biopsy at this time should be based on the\nclinical assessment.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her annual\nmammogram.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nNo mass, suspicious microcalcifications, or unexplained architectural\ndistortion is seen.\n\nRIGHT BREAST ULTRASOUND: The upper central right breast was scanned and\nnormal breast tissue was identified.", + "output": "No evidence for malignancy.\n\nRECOMMENDATION(S): Clinical followup is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nNo mass, suspicious microcalcifications, or unexplained architectural\ndistortion is seen.\n\nRIGHT BREAST ULTRASOUND: The upper central right breast was scanned and\nnormal breast tissue was identified.", + "output": "No evidence for malignancy.\n\nRECOMMENDATION(S): Clinical followup is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nTriangular focal breast pain marker overlying the slightly upper inner left\nbreast. There is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. No significant change.\n\nBREAST ULTRASOUND: Targeted ultrasound in the area of pain as identified by\nthe patient at 12 o'clock 4 cm from the nipple, 10 o'clock 7 cm from nipple,\nand 12 o'clock 2 cm from the nipple was performed which was without any\ndiscrete suspicious solid or cystic masses. Additionally the left breast 9\nthrough 12 o'clock 1-10 cm from the nipple was scanned without discrete\nsuspicious solid or cystic masses.", + "output": "There is no specific mammographic evidence of malignancy. Targeted ultrasound\nin the area of pain demonstrated no suspicious sonographic abnormality. Any\ndecision for further intervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up, age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are no spiculated masses suspicious grouped microcalcifications or areas\nof architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left retroareolar region was\nperformed. In the left retroareolar region there are 2 well-circumscribed\nhypoechoic masses measuring 0.4 x 0.3 x 0.3 cm and a second intraductal mass\nmeasuring 0.5 x 0.4 x 0.5 cm with some peripheral vascular. A proximal\nprominent duct is noted.", + "output": "Masses in the left retroareolar region, likely papillomas.\nOption of ultrasound-guided biopsy for definitive diagnosis was discussed with\nthe patient.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the transplant kidney was targeted and 3 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was not administered.", + "output": "Ultrasound guidance for percutaneous right lower quadrant transplant kidney\nbiopsy." + }, + { + "input": "The liver appears normal in grayscale appearance, size, without focal lesion.\nThere is no biliary ductal dilation with the common bile duct measuring 3-mm. \nThe main portal vein is patent with hepatopetal flow. The gallbladder appears\nnormal. The pancreas appears normal. Both kidneys are normal in grayscale\nappearance, size without focal concerning lesion. The spleen is normal. \nLimited views of the right lower quadrant failed to demonstrate an abnormal\nappendix.\n\nPelvic ultrasound demonstrates a normal appearance of the uterus which\nmeasures 7.3 x 3.2 x 4.8 cm. The endometrium is thin and homogeneously\nechogenic measuring 2 mm in thickness. Trace fluid in the cervical canal is\nnoted. Both ovaries are normal in grayscale appearance and size with normal\nvascularity. No adnexal mass.", + "output": "Normal ultrasound of the abdomen and pelvis." + }, + { + "input": "Heterogeneous right thyroid nodule measuring 1.6 x 1.7 x 2.5 cm, as seen on\n___ ultrasound.", + "output": "Uncomplicated ultrasound-guided fine needle aspiration of right thyroid\nnodule." + }, + { + "input": "RIGHT:\nThere is no atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 73.9 cm/s / 14.7 cm/s\nCCA Distal: 74.5 cm/s / 17.6 cm/s\nICA ___: 45.6 cm/s / 13.4 cm/s\nICA Mid: 79.4 cm/s / 29.5 cm/s\nICA Distal: 65.8 cm/s / 28.1 cm/s\nECA: 56.7 cm/s\nVertebral: 53.4 cm/s\n\nICA/CCA Ratio: 1.07\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 77.8 cm/s / 18.1 cm/s\nCCA Distal: 68.4 cm/s / 22.8 cm/s\nICA ___: 25.9 cm/s / 6.9 cm/s\nICA Mid: 69.8 cm/s / 24 cm/s\nICA Distal: 57.2 cm/s / 20.6 cm/s\nECA: 68.4 cm/s\nVertebral: 46.7 cm/s\n\n\nICA/CCA Ratio: 1.02\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA no stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "There is normal flow with respiratory variation in the bilateral subclavian\nveins.\n\nThe right internal jugular vein appears patent.\n\nIncomplete compressibility of the right axillary vein, with internal mural\nechogenic content, is consistent with partial thrombosis. There is asymmetric\nmural thickening of the basilic vein, possibly representing nonocclusive\nthrombus extending from the axillary. Adequate compressibility of the brachial\nand cephalic veins is noted, with internal Doppler flow.", + "output": "1. Partial thrombosis of the right axillary vein\n2. Equivocal partial thrombosis of the basilic vein.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 12:13 ___." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ ___ catheter was advanced into the largest fluid pocket in the\nright lower quadrant and 6 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Successful ultrasound-guided paracentesis, with 6 L of fluid aspirated via the\nright lower quadrant. No immediate postprocedure complications. A sample was\nsent for further laboratory analysis and microbiology at the request of the\nprimary team." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1 L of clear, straw-colored fluid was removed. Requested\nfluid samples were submitted to the laboratory.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis with removal of 1 L of clear, straw-colored fluid. Requested\nfluid samples were submitted to the laboratory." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.3 L of clear, straw-colored fluid was removed. Requested\nfluid samples were submitted to the laboratory.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis with removal of 3.3 L of ascitic fluid from the right lower\nquadrant. Requested fluid samples were submitted to the laboratory." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.1 L of clear, straw-colored fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Ultrasound-guided diagnostic and therapeutic paracentesis with 2.1 L of\nascitic fluid removed without complications." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed. Sample of ascites fluid was sent for cell count\nand microbiology." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.0 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of straw colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.0 L of clear, red-tinged fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis.\n2. 3.0 L of fluid were removed." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 17 mm circumscribed oval equal density mass in the upper-outer left\nbreast. There is an approximately 9 mm oval asymmetry in the outer left\nbreast, suggesting a mass. Asymmetry in the inner right breast on the initial\ncraniocaudal view does not persist on spot compression 2D or 3D view,\nconsistent with normal superimposed breast tissue. There are no suspicious\ngrouped calcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: Ultrasound of the outer left breast was performed. At 3\no'clock position 1 cm from the nipple there is an 8 x 4 x 9 mm oval parallel\nhypoechoic circumscribed mass, corresponding to an oval asymmetry in the outer\nleft breast. At 1 o'clock position 6 cm from the nipple there is a 1.5 x 1.1\nx 0.6 cm well-circumscribed heterogeneous predominantly hypoechoic mass,\ncorresponding to the well-circumscribed mass in the upper-outer left breast on\nmammography.", + "output": "There are 2 probably benign masses in the upper-outer left breast. Short-term\ninterval followup to document stability is recommended. No specific\nmammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Short-term interval followup of the left breast with\nmammogram and ultrasound in 6 months to document stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 17 mm circumscribed oval equal density mass in the upper-outer left\nbreast. There is an approximately 9 mm oval asymmetry in the outer left\nbreast, suggesting a mass. Asymmetry in the inner right breast on the initial\ncraniocaudal view does not persist on spot compression 2D or 3D view,\nconsistent with normal superimposed breast tissue. There are no suspicious\ngrouped calcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: Ultrasound of the outer left breast was performed. At 3\no'clock position 1 cm from the nipple there is an 8 x 4 x 9 mm oval parallel\nhypoechoic circumscribed mass, corresponding to an oval asymmetry in the outer\nleft breast. At 1 o'clock position 6 cm from the nipple there is a 1.5 x 1.1\nx 0.6 cm well-circumscribed heterogeneous predominantly hypoechoic mass,\ncorresponding to the well-circumscribed mass in the upper-outer left breast on\nmammography.", + "output": "There are 2 probably benign masses in the upper-outer left breast. Short-term\ninterval followup to document stability is recommended. No specific\nmammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Short-term interval followup of the left breast with\nmammogram and ultrasound in 6 months to document stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque. A patent stent\nis seen within the right internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 120 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 96, 69, and 121 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 176 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque. A patent stent is\nseen within the left internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 127 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 149, 116, and 115 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 43 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 177 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Patent stents are seen within the bilateral carotid arteries, with\nvelocities as described." + }, + { + "input": "Tissue density: It measures at least 5.2 x 4.3 cm are accurate measurements\nmay be determined on the breast ultrasounds. The left breast is normal\nIn the right breast is a large mass with associated architectural distortion\nand innumerable microcalcifications. Mammographically its borders are\nill-defined and the margins are irregular\n\n\nBREAST ULTRASOUND: Examination reveals a hypoechoic very ill-defined\nmultilobulated mass producing intense acoustic shadowing. It measures at\nleast 4.1 cm x 3.4 x 3.9 cm by ultrasound examination. Microcalcifications\nare identified. No lymphadenopathy is detected within the axilla.", + "output": "Probable malignancy\n\nRECOMMENDATION(S): The Findings on the significance has been discussed with\nthe patient. She has agreed to undergo immediate ultrasound-guided core\nbiopsy and skin punch biopsy we performed by the surgical service immediately\nthereafter\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Targeted ultrasound 11 o'clock right breast, 3 cm from the nipple, again\ndemonstrates a large poorly defined mass with internal calcifications which\nwas targeted for biopsy. At the inferior aspect of the right axilla, there is\na mildly enlarged low axillary lymph node with slight acentric cortical\nthickening measuring 3.4 mm which was also targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\n\nClinicians: ___. ___, MD. ___ procedure was supervised by ___. \n___, M.D.\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle and 14-gauge Bard spring-loaded biopsy device were used to\nobtain 5 cores of the right breast mass. Next, a percutaneous ribbon clip was\ndeployed under ultrasound guidance.\n\nUsing ultrasound-guidance, aseptic technique, and local anesthesia, a 13 gauge\ncoaxial needle and 16 gauge Achieve needle were used to obtain 5 course of the\nlow right axillary lymph node. Next, a percutaneous heart clip was deployed\nunder ultrasound-guided.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications:No immediate Complications\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof the ribbon clip in the right breast mass. The heart clip within the right\naxillary lymph node is not seen within the field of view due to its far\nposterior location.", + "output": "Successful US-guided core biopsy of the right breast mass and right axillary\nlymph node. Pathology is pending.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the BreastCare Center provider with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted ultrasound 11 o'clock right breast, 3 cm from the nipple, again\ndemonstrates a large poorly defined mass with internal calcifications which\nwas targeted for biopsy. At the inferior aspect of the right axilla, there is\na mildly enlarged low axillary lymph node with slight acentric cortical\nthickening measuring 3.4 mm which was also targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\n\nClinicians: ___. ___, MD. ___ procedure was supervised by ___. \n___, M.D.\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle and 14-gauge Bard spring-loaded biopsy device were used to\nobtain 5 cores of the right breast mass. Next, a percutaneous ribbon clip was\ndeployed under ultrasound guidance.\n\nUsing ultrasound-guidance, aseptic technique, and local anesthesia, a 13 gauge\ncoaxial needle and 16 gauge Achieve needle were used to obtain 5 course of the\nlow right axillary lymph node. Next, a percutaneous heart clip was deployed\nunder ultrasound-guided.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications:No immediate Complications\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof the ribbon clip in the right breast mass. The heart clip within the right\naxillary lymph node is not seen within the field of view due to its far\nposterior location.", + "output": "Successful US-guided core biopsy of the right breast mass and right axillary\nlymph node. Pathology is pending.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the BreastCare Center provider with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Tissue density: It measures at least 5.2 x 4.3 cm are accurate measurements\nmay be determined on the breast ultrasounds. The left breast is normal\nIn the right breast is a large mass with associated architectural distortion\nand innumerable microcalcifications. Mammographically its borders are\nill-defined and the margins are irregular\n\n\nBREAST ULTRASOUND: Examination reveals a hypoechoic very ill-defined\nmultilobulated mass producing intense acoustic shadowing. It measures at\nleast 4.1 cm x 3.4 x 3.9 cm by ultrasound examination. Microcalcifications\nare identified. No lymphadenopathy is detected within the axilla.", + "output": "Probable malignancy\n\nRECOMMENDATION(S): The Findings on the significance has been discussed with\nthe patient. She has agreed to undergo immediate ultrasound-guided core\nbiopsy and skin punch biopsy we performed by the surgical service immediately\nthereafter\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 92 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 71, 79, and 78 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.86.\nThe external carotid artery has peak systolic velocity of 136. Cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 110. Cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 83, 73, and 85 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.77.\nThe external carotid artery has peak systolic velocity of 130. Cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "Three fine needle aspiration passes were performed on the mixed solid / cystic\nright thyroid nodule measuring 5.7 x 4.1 x 7.4 cm. An additional 18 cc of\nfluid was aspirated and sent for analysis.", + "output": "Technically successful fine-needle aspiration of a right thyroid lobe nodule. \nAdditional 18 cc of fluid was aspirated. Specimen and fluid were sent to\ncytology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 25.4, 43, and 63 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21.3 cm/sec.\nThe ICA/CCA ratio is 0.83.\nThe external carotid artery has peak systolic velocity of 45 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 29, 46, and 47 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 0.68.\nThe external carotid artery has peak systolic velocity of 27 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the carotid systems bilaterally" + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is an irregular, spiculated, hyperdense mass measuring 3.3 x 2.5 x 2.1\ncm in the upper outer right breast, anterior depth corresponding to the\npalpable abnormality of concern. Additionally, there is a 1.8 x 1.3 x 1.1 cm\noval, circumscribed, hyperdense mass in the upper outer right breast\nconcerning for a metastatic lymph node. Otherwise, there is no suspicious\nabnormality within the left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. There is a 2.7 x 2.6 x\n2.4 cm irregular, hypoechoic mass with angulated margins corresponding to the\nmammographic abnormality of concern. Additionally, there is a 2.5 cm oval,\ncircumscribed, hypoechoic mass concerning for an abnormal lymph node\ncorresponding to the mammographic abnormality of concern at the 10 o'clock\nposition of the right breast 12 cm from the nipple. Adjacent to this abnormal\nlymph node is an additional lymph node with a cortex measuring approximately 7\nmm which is labeled at the 10 o'clock position approximately 11 cm from the\nnipple concerning for an additional area of disease. Otherwise, within the\nremainder of the right axilla, an additional normal appearing lymph node is\nidentified.", + "output": "1. 2.7 x 2.6 x 2.4 cm irregular mass within the right breast corresponding to\nthe patient's palpable abnormality of concern. This is highly suggestive of\nmalignancy and ultrasound-guided core needle biopsy is recommended for further\nevaluation.\n2. Suspicious appearing lymph nodes at the 10 o'clock position approximately\n12 and 11 cm from the nipple. Fine-needle aspiration is recommended of the\nabnormal lymph node at the 10 o'clock position 12 cm from the nipple which\nalso corresponds to the mammographic abnormality of concern.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast. \nUltrasound-guided FNA of an abnormal lymph node.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. The patient will return for biopsy on ___\nat 14:30.\n\nResults were also emailed by Dr. ___ to Dr. ___ on ___ at\n17:32.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is an irregular, spiculated, hyperdense mass measuring 3.3 x 2.5 x 2.1\ncm in the upper outer right breast, anterior depth corresponding to the\npalpable abnormality of concern. Additionally, there is a 1.8 x 1.3 x 1.1 cm\noval, circumscribed, hyperdense mass in the upper outer right breast\nconcerning for a metastatic lymph node. Otherwise, there is no suspicious\nabnormality within the left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. There is a 2.7 x 2.6 x\n2.4 cm irregular, hypoechoic mass with angulated margins corresponding to the\nmammographic abnormality of concern. Additionally, there is a 2.5 cm oval,\ncircumscribed, hypoechoic mass concerning for an abnormal lymph node\ncorresponding to the mammographic abnormality of concern at the 10 o'clock\nposition of the right breast 12 cm from the nipple. Adjacent to this abnormal\nlymph node is an additional lymph node with a cortex measuring approximately 7\nmm which is labeled at the 10 o'clock position approximately 11 cm from the\nnipple concerning for an additional area of disease. Otherwise, within the\nremainder of the right axilla, an additional normal appearing lymph node is\nidentified.", + "output": "1. 2.7 x 2.6 x 2.4 cm irregular mass within the right breast corresponding to\nthe patient's palpable abnormality of concern. This is highly suggestive of\nmalignancy and ultrasound-guided core needle biopsy is recommended for further\nevaluation.\n2. Suspicious appearing lymph nodes at the 10 o'clock position approximately\n12 and 11 cm from the nipple. Fine-needle aspiration is recommended of the\nabnormal lymph node at the 10 o'clock position 12 cm from the nipple which\nalso corresponds to the mammographic abnormality of concern.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast. \nUltrasound-guided FNA of an abnormal lymph node.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. The patient will return for biopsy on ___\nat 14:30.\n\nResults were also emailed by Dr. ___ to Dr. ___ on ___ at\n17:32.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "2.7 x 2.7 x 2.9 cm irregular hypoechoic mass with angulated margins at 10\no'clock 7 cm from the nipple which was targeted for ultrasound-guided core\nbiopsy. Abnormal intramammary lymph node at 10 o'clock 11 cm from the nipple\nwhich was targeted for FNA. Additional abnormal axillary lymph node is noted\nat 10 o'clock 12 cm from the nipple, as seen on the prior ultrasound.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nClinicians: ___, M.D. The procedure was supervised by\n___, M.D (attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and 5 cores were\nobtained using a 14-gauge hologic sertera spring-loaded biopsy device. Next,\na percutaneous CeleroMark dumbbell was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nAXILLARY LYMPH NODE FNA: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, fine needle aspiration of the abnormal right intramammary\nlymph node was performed using 22 gauge needles and 4 passes. Next, a\npercutaneous HydroMARK coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the right breast mass and abnormal intramammary lymph node.", + "output": "Technically successful US-guided core biopsy and fine needle aspiration. \nPathology and FNA are pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "2.7 x 2.7 x 2.9 cm irregular hypoechoic mass with angulated margins at 10\no'clock 7 cm from the nipple which was targeted for ultrasound-guided core\nbiopsy. Abnormal intramammary lymph node at 10 o'clock 11 cm from the nipple\nwhich was targeted for FNA. Additional abnormal axillary lymph node is noted\nat 10 o'clock 12 cm from the nipple, as seen on the prior ultrasound.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nClinicians: ___, M.D. The procedure was supervised by\n___, M.D (attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and 5 cores were\nobtained using a 14-gauge hologic sertera spring-loaded biopsy device. Next,\na percutaneous CeleroMark dumbbell was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nAXILLARY LYMPH NODE FNA: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, fine needle aspiration of the abnormal right intramammary\nlymph node was performed using 22 gauge needles and 4 passes. Next, a\npercutaneous HydroMARK coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the right breast mass and abnormal intramammary lymph node.", + "output": "Technically successful US-guided core biopsy and fine needle aspiration. \nPathology and FNA are pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Targeted ultrasound of the right breast and right axilla was performed. An\nintramammary node is again seen at the to ___ position 3 cm from the nipple\nwith eccentric cortical thickening, which was targeted for the\nultrasound-guided fine-needle aspiration and clip placement per discussion\nwith Dr. ___.\n\nA large hypoechoic oval lower axillary lymph node was seen on the right,\napproximately 10:00 position 13 cm from the nipple measuring approximately 2.1\ncm. This was targeted for the ultrasound-guided clip placement per discussion\nwith Dr. ___.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nThe procedure was supervised by M. ___, M.D.(Attending).\n\nDescription:\nAXILLARY LYMPH NODE: Using ultrasound guidance, aseptic technique and local\nanesthesia, a ribbon clip was placed into the enlarged right axillary lymph\nnode. The needle was removed and hemostasis was achieved.\n\nINTRAMAMMARY LYMPH NODE: Then, using ultrasound guidance, aseptic technique\nand local anesthesia, 22 and 25 gauge needles were placed into the small\nintramammary lymph node and 3 passes were made for fine-needle aspiration. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement in the lower outer intramammary lymph node as well as the lower\naxillary lymph node.", + "output": "Technically successful US-guided fine needle aspiration of right intramammary\nlymph node with clip placement and ultrasound-guided clip placement of right\nlower axillary lymph node. Cytology results are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "At ___ o'clock position, 3 cm from the nipple an oval hypoechoic circumscribed\nmass is seen with central echogenic component showing vascularity, measuring\n1.1 x 0.5 x 0.6 cm, consistent with intramammary lymph node and corresponding\nto finding on recent MRI. Lymph node demonstrates mild eccentric cortical\nthickening up to 3 mm.\n\nThere is an enlarged rounded right axillary lymph node with abnormal\nmorphology at approximately 10 o' clock position 13 cm from the nipple\nmeasuring 2.1 x 1.2 x 1.4 cm, corresponding to lymph node identified on prior\nultrasound ___ at the 10 o'clock position 12 cm from the nipple and\nthe lower axillary node on recent MRI..", + "output": "1. Intramammary lymph node in the right breast ___ o'clock position 3 cm from\nthe nipple, corresponding to the abnormality seen on the recent breast MRI\nwith mild eccentric cortical thickening, which is indeterminate. While this\nmay be reactive from recent biopsies, extent of malignant disease should be\nexcluded given diagnosis.\n2. Enlarged rounded right axillary lymph node with abnormal morphology,\ncorresponding to MRI finding and previously identified lymph node on\nultrasound ___, high suspicion for malignancy.\n\nRECOMMENDATION(S): Management of the additional right intramammary lymph node\nand lower axillary lymph node per oncologic team, with options including clip\nplacement and ultrasound-guided FNA. Alternatively, the lower axillary node\ncould be targeted at the time of surgical excision and sentinel lymph node\nbiopsy or sampled in the pre-surgical setting.\n\nNOTIFICATION: Findings and recommendations were communicated by Dr. ___\nto Dr. ___ at the time of imaging confirmation. Based on the discussion,\nDr. ___ clip placement in the lower axillary node and FNA with\nclip placement in the intramammary node. Further management will be discussed\nat the patient's upcoming multi disciplinary clinic visit ___. \nFindings and recommendation for biopsy were reviewed with the patient who\nagrees with the plan. She was given information to schedule her FNA in clip\nplacement immediately following imaging.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Targeted ultrasound of the right breast and right axilla was performed. An\nintramammary node is again seen at the to ___ position 3 cm from the nipple\nwith eccentric cortical thickening, which was targeted for the\nultrasound-guided fine-needle aspiration and clip placement per discussion\nwith Dr. ___.\n\nA large hypoechoic oval lower axillary lymph node was seen on the right,\napproximately 10:00 position 13 cm from the nipple measuring approximately 2.1\ncm. This was targeted for the ultrasound-guided clip placement per discussion\nwith Dr. ___.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nThe procedure was supervised by M. ___, M.D.(Attending).\n\nDescription:\nAXILLARY LYMPH NODE: Using ultrasound guidance, aseptic technique and local\nanesthesia, a ribbon clip was placed into the enlarged right axillary lymph\nnode. The needle was removed and hemostasis was achieved.\n\nINTRAMAMMARY LYMPH NODE: Then, using ultrasound guidance, aseptic technique\nand local anesthesia, 22 and 25 gauge needles were placed into the small\nintramammary lymph node and 3 passes were made for fine-needle aspiration. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement in the lower outer intramammary lymph node as well as the lower\naxillary lymph node.", + "output": "Technically successful US-guided fine needle aspiration of right intramammary\nlymph node with clip placement and ultrasound-guided clip placement of right\nlower axillary lymph node. Cytology results are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "At 10:00 position 13 cm from the nipple in the right axillary tail/lower\naxilla again seen is an enlarged lymph node measuring 2.6 x 1.6 x 1.5 cm. A\nbiopsy clip is seen within this lymph node.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 2\ncores were obtained using a 14-gauge Sertera spring-loaded biopsy device using\na no-throw technique. Then, 1 core was obtained using a 16-gauge Achive\nneedle using a no-throw technique. No new clip was deployed as the previously\nplaced clip was seen. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No hematoma was seen. The patient complained of right arm pain\nfollowing the procedure. ___, N.P. was notified immediately\nafter the procedure. The patient was directed to the Breast Care Center to be\nseen by ___.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided core biopsy of the right axillary lymph node.\nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Mild synovial thickening visualized in the left sternoclavicular joint with\nmild surrounding hyperemia. Images demonstrate needle within the left\nsternoclavicular joint.", + "output": "Tiny volume of fluid aspirated from the left sternoclavicular joint after\ninjection of 1 cc of sterile saline." + }, + { + "input": "Multiple hypoechoic liver lesions, as seen on ___ CT abdomen and\npelvis. A dominant 6 cm lesion in the right hepatic lobe was targeted for\nbiopsy.", + "output": "Successful ultrasound-guided core biopsy of a dominant lesion the right\nhepatic lobe. Samples were sent for pathology." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated small to\nmoderate amount of ascites. A suitable target in the deepest pocket in the\nright lower quadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.75 L of straw-colored fluid was removed.\n\nFluid samples were submitted for laboratory evaluation, as requested by the\nordering provider.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, with removal of 1.75 L of straw-colored fluid." + }, + { + "input": "Ultrasound the right common femoral artery: There is an obvious arterial\nlumen. There is notation of the needle within the lumen.\n\nRight internal carotid artery: There is a previous clip on the right ICA. \nThere is artifact from a previous craniotomy. Vessel caliber smooth and\nregular. There is filling of the anterior middle cerebral arteries and their\ndistal territories. There is no evidence of vasospasm. There is no evidence\nof additional aneurysm or AVM. High magnification views reveal a 6 by 3 mm\nresidual adjacent to the clip. Vessel caliber smooth and regular.\n\nRight internal carotid artery following pipeline deployment: Vessel caliber\nsmooth and regular. There is no evidence of vessel dropout. The anterior\nmiddle cerebral artery is fill as do their distal territories. There is no\nevidence of InStent stenosis. There is good wall apposition between the\npipeline in the native vessel. The pipeline was fully deployed it open. It\ncovers the neck of the aneurysm adequately. The residual area is still\nfilling.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection.", + "output": "Successful pipeline embolization of previously clipped right para ophthalmic\ninternal carotid artery aneurysm residual\n\nRECOMMENDATION(S):\n1. Follow-up in 6 months with an angiogram per pipeline protocol." + }, + { + "input": "Ultrasound the left common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nRight internal carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral arteries no distal territories. \nThere is a clip in the para ophthalmic position the right internal carotid\nartery. There is a pipeline crossing this region within the parent artery. \nThere is no evidence of residual aneurysm. The residual aneurysm that had\npreviously been noted no longer fills. There is no evidence of InStent\nstenosis or endoleak. There is no evidence of additional aneurysm or AVM. \nThe venous phase is unremarkable. The closure of the previous residual is\ncorroborated on three-dimensional rotational imaging. The previous residual\nmeasured 3 x 3 mm.\n\nLeft common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "No residual filling of residual right para ophthalmic artery aneurysm after\nclipping ___ years ago treated with pipeline embolization at six-month\nfollow-up.\n\n___ 1\n\nRECOMMENDATION(S):\n1. Follow-up per protocol" + }, + { + "input": "Targeted ultrasound of the left axilla was performed in the area of prior pain\nand palpable concern as indicated by the patient. No suspicious solid or\ncystic mass or other sonographic abnormality was identified.", + "output": "No specific evidence of malignancy in the left axilla.\n\nRECOMMENDATION(S): Clinical follow-up for left axillary pain and palpable\nlump.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Ultrasound was performed of the left axilla and left breast from 2 o'clock\n1-12 cm from the nipple. No suspicious solid or cystic mass was identified.", + "output": "No suspicious findings in the area of concern in the left axilla and left\nbreast. Clinical follow-up is recommended.\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 53 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 49, 95, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.8.\nThe external carotid artery has peak systolic velocity of 62 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 42, 79, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 49 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis bilaterally." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nAn asymmetry in the posterior depth right outer breast does not persist on\nadditional imaging indicating that this represents overlapping breast\nparenchyma. Normal fibroglandular parenchyma is seen in the left axillary\nregion corresponding to the area of clinical concern. This is consistent with\naccessory breast parenchyma. There is no dominant mass, suspicious\nmicrocalcifications or focal architectural distortion in either breast.\n\nLEFT BREAST ULTRASOUND:\n\nThe left axilla and left lower outer quadrant was scanned. Normal\nfibroglandular tissue is seen in the left axilla correlating with the findings\nseen on the mammogram consistent with accessory breast parenchyma. Normal\nbreast parenchyma without any solid or cystic mass is seen in the ___ o'clock\nof the site of pain indicated by the patient.", + "output": "Accessory breast parenchyma in the left axilla without any suspicious imaging\nfeatures corresponding to the area of fullness. No abnormality identified in\nthe left breast at the site of pain.\nNo evidence of malignancy.\n\nRECOMMENDATION: Age and risk appropriate screening is recommended. Final\ndisposition of patient's symptoms should be based on clinical grounds.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nAn asymmetry in the posterior depth right outer breast does not persist on\nadditional imaging indicating that this represents overlapping breast\nparenchyma. Normal fibroglandular parenchyma is seen in the left axillary\nregion corresponding to the area of clinical concern. This is consistent with\naccessory breast parenchyma. There is no dominant mass, suspicious\nmicrocalcifications or focal architectural distortion in either breast.\n\nLEFT BREAST ULTRASOUND:\n\nThe left axilla and left lower outer quadrant was scanned. Normal\nfibroglandular tissue is seen in the left axilla correlating with the findings\nseen on the mammogram consistent with accessory breast parenchyma. Normal\nbreast parenchyma without any solid or cystic mass is seen in the ___ o'clock\nof the site of pain indicated by the patient.", + "output": "Accessory breast parenchyma in the left axilla without any suspicious imaging\nfeatures corresponding to the area of fullness. No abnormality identified in\nthe left breast at the site of pain.\nNo evidence of malignancy.\n\nRECOMMENDATION: Age and risk appropriate screening is recommended. Final\ndisposition of patient's symptoms should be based on clinical grounds.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the right knee demonstrated a moderate\nto large right knee effusion.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 25 gauge needle was inserted into the right knee effusion under direct\nultrasound guidance and approximately 15 cc of clear, straw-colored fluid with\ndebris was aspirated. This was sent for cell count, crystals and\nmicrobiological examination.\n\nThe patient tolerated the procedure well without immediate complication. No\nbleeding was evident during or after the Procedure.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided right knee aspiration." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular and\nfibronodular density.\nIn the upper, outer right breast at posterior depth there is a 1.2 cm oval\nmass, which appears little changed since at least ___. Spot\ncompression views reveal the mass has circumscribed borders. It was further\nevaluated with targeted ultrasound. Otherwise, there is no suspicious mass,\nunexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the region of\nmammographic mass in the upper, outer right breast. No suspicious solid or\ncystic mass is identified. No ultrasound correlate seen.", + "output": "A 1.2 cm oval circumscribed mass in the upper, outer right breast without\nultrasound correlate appears ___ changed dating to at least ___,\nconsistent with a benign process.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 13\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "There is a midline anterior abdominal wall fluid collection. Subsequent\nimages demonstrate drainage catheter within the collection.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\nmidline abdominal wall abscess. Samples was sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild, heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 98 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 75 cm/s, 89 cm/s, and 94 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.95.\nThe external carotid artery has peak systolic velocity of93 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild, heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 85 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 72 cm/s, 81 cm/s, and 49 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.95.\nThe external carotid artery has peak systolic velocity of 82 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "< 40% stenosis of the right internal carotid artery.\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight: There is a 1.5 x 0.7 cm circumscribed mass in the right upper outer\nquadrant at middle depth consistent with the cysts seen on ultrasound at 9\no'clock. There is no specific dominant mass at the location of the BB.\nThere is no suspicious dominant mass or suspicious grouped calcifications.\n\nLeft: The left breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications. A 6 mm oval\narea of asymmetry is noted in the retroareolar region, which corresponds to\nthe cyst seen on ultrasound at 12 o'clock. There is no specific mass seen\nsubjacent to the BB.\n\nBILATERAL BREAST ULTRASOUND:\nRight: Targeted ultrasound of the right breast at the patient's clinical area\nof concern at 10 o'clock 6 cm from the nipple demonstrates a 6 x 2 x 6 mm\nsimple cyst.\n\nTargeted ultrasound of the right breast at 9 o'clock 4 cm from the nipple\ndemonstrates a group of 3 simple anechoic avascular cysts together measuring\n1.6 x 0.7 x 1.5 cm.\n\nTargeted ultrasound of the right breast at ___ o'clock is unremarkable.\n\nLeft: Targeted ultrasound of the patient's clinical area in the upper outer\nquadrant demonstrates a few simple cysts, the largest of which is at 1 o'clock\n6 cm from the nipple measuring 9 x 2 x 5 mm.\n\nTargeted ultrasound of the retroareolar region at 12 o'clock 0-2 cm from the\nnipple demonstrates a 6 x 4 x 6 mm simple cyst.\n\nTargeted ultrasound of the left breast at ___ o'clock is unremarkable.", + "output": "No specific evidence of malignancy. Bilateral benign-appearing cysts.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is mild heterogeneous plaque in calcifications of the right proximal\ninternal carotid artery.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n87/26 cm/sec in its proximal portion, 97/23 cm/sec in its mid portion, and\n84/24 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n80/16 cm/sec.\nThe external carotid artery has peak systolic velocity of 92 cm/sec.\nThe vertebral artery has peak systolic velocity of 64 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.2.\n\nLEFT:\nThere is moderate heterogeneous plaque and calcifications of the proximal ICA\nand ECA\nThe left internal carotid artery has peak systolic/diastolic velocities of\n135/35 cm/sec in its proximal portion, 120/31 cm/sec in its mid portion, and\n74/19 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 89/15\ncm/sec.\nThe external carotid artery has peak systolic velocity of 92 cm/sec.\nThe vertebral artery has peak systolic velocity of 48 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.5.", + "output": "1. Less than 40% stenosis of the right internal carotid artery due to mild\nheterogeneous plaque.\n\n2. 40-59% stenosis of the left internal carotid artery due to moderate\nheterogeneous plaque." + }, + { + "input": "There is normal respiratory variation in both common femoral veins.\n\nThere is normal compressibility and augmentation of both common femoral,\nfemoral, popliteal, posterior tibial, peroneal, greater and lesser saphenous\nveins. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis to the popliteal level." + }, + { + "input": "Hepatic dome lesion seen on recent CT abdomen pelvis was identified and deemed\namenable to biopsy.", + "output": "Successful ultrasound-guided targeted liver biopsy of hepatic dome lesion. No\nimmediate postprocedure complication." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the transplant kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Please refer to nephrology notes for sedation details.", + "output": "Ultrasound guidance for percutaneous transplant kidney biopsy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast:\nThere is a subpectoral silicone implant with intact anterior margins where\nvisualized. There is no suspicious dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. Postoperative changes are seen with\narchitectural distortion in the central inferior right breast.\n\nLeft breast:\nThere is a subpectoral silicone implant with intact anterior margins where\nvisualized.. Anterior to the implant, there is a stable, oval, circumscribed,\nhigh-density mass, measuring 4.9 x 2.7 x 3.0 cm. This is under the BB marker.\nThere is a single benign-appearing calcification along the posterior margin of\nthis mass and other benign calcifications are seen. Postoperative changes are\nseen with architectural distortion consistent with prior surgery. No other\nsuspicious dominant masses are identified.\n\nLEFT BREAST ULTRASOUND:\nTargeted ultrasound of the palpable lump in the left upper outer quadrant ___\no'clock 7-8 cm from the nipple demonstrates an oval circumscribed 5.1 x 2.0 x\n4.5 cm heterogeneous mass with hyperechoic anterior rim and some internal\ncystic spaces, without dominant vascularity or posterior shadowing. The\nappearance is similar to the prior study of ___ and is most consistent with a\nsilicone granuloma or other benign entity.", + "output": "No specific evidence of malignancy. Long-term stability of the 5.1 cm left\nbreast mass which is likely a silicone granuloma or other benign entity.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given the phone number the breast Care Center\nas she wishes to have this mass removed in the ___.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast:\nThere is a subpectoral silicone implant with intact anterior margins where\nvisualized. There is no suspicious dominant mass, architectural distortion or\nsuspicious grouped microcalcifications. Postoperative changes are seen with\narchitectural distortion in the central inferior right breast.\n\nLeft breast:\nThere is a subpectoral silicone implant with intact anterior margins where\nvisualized.. Anterior to the implant, there is a stable, oval, circumscribed,\nhigh-density mass, measuring 4.9 x 2.7 x 3.0 cm. This is under the BB marker.\nThere is a single benign-appearing calcification along the posterior margin of\nthis mass and other benign calcifications are seen. Postoperative changes are\nseen with architectural distortion consistent with prior surgery. No other\nsuspicious dominant masses are identified.\n\nLEFT BREAST ULTRASOUND:\nTargeted ultrasound of the palpable lump in the left upper outer quadrant ___\no'clock 7-8 cm from the nipple demonstrates an oval circumscribed 5.1 x 2.0 x\n4.5 cm heterogeneous mass with hyperechoic anterior rim and some internal\ncystic spaces, without dominant vascularity or posterior shadowing. The\nappearance is similar to the prior study of ___ and is most consistent with a\nsilicone granuloma or other benign entity.", + "output": "No specific evidence of malignancy. Long-term stability of the 5.1 cm left\nbreast mass which is likely a silicone granuloma or other benign entity.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given the phone number the breast Care Center\nas she wishes to have this mass removed in the ___.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses were performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 11 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 91 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 79, 81, and 52 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.89.\nThe external carotid artery has peak systolic velocity of 64 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 46, 40, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.79.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous atherosclerotic plaque involving the internal carotid\narteries with less than 40% stenosis of each internal carotid artery." + }, + { + "input": "Preprocedural imaging redemonstrates a left breast mass at ___ o'clock, 6 cm\nfrom nipple for which an ultrasound-guided core biopsy is recommended.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.clinicians The procedure was supervised by ___,\nM.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views demonstrate expected postop\nbiopsy changes and confirm appropriate clip placement.", + "output": "Technically successful US-guided core biopsy of the left breast mass.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Targeted sonographic examination of the lower outer left breast was performed.\nAt ___ o'clock, 6 cm from nipple there is an oval hypoechoic circum mass\nmeasuring 0.6 x 0.3 x 0.7 cm without internal vascularity or posterior\nacoustic shadowing and is felt to correspond to the MRI finding. This mass\nlikely contains small calcifications. An ultrasound-guided core biopsy is\nrecommended. Adjacent to this mass is a 0.6 x 0.5 x 0.2 cm normal lymph node\nwhich likely corresponds to an area of enhancement seen on MRI adjacent to the\nmass.", + "output": "Left breast mass at ___ o'clock 6 cm from nipple felt to correspond to the MRI\nfinding for which MRI guided biopsy is recommended\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of left breast mass which\nwill be performed immediately after this exam.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan. The biopsy will be performed immediately\nafter this exam.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Preprocedural imaging redemonstrates a left breast mass at ___ o'clock, 6 cm\nfrom nipple for which an ultrasound-guided core biopsy is recommended.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.clinicians The procedure was supervised by ___,\nM.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views demonstrate expected postop\nbiopsy changes and confirm appropriate clip placement.", + "output": "Technically successful US-guided core biopsy of the left breast mass.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Targeted ultrasound of the right chest wall at 12 o'clock, 7 cm above the\nsurgical scar demonstrates a superficial, oval, circumscribed, hyperechoic\nmass measuring 0.5 x 0.3 x 0.4cm without internal vascularity. This likely\nrepresents a focus of fat necrosis and corresponds to the palpable\nabnormality.\n\nTargeted ultrasound of the left axilla in the region of swelling and\ntenderness demonstrates no suspicious cystic or solid mass. There is no\naxillary lymphadenopathy.", + "output": "1. 0.6 cm echogenic mass in the area of concern in the right chest wall is\nprobably benign, likely fat necrosis. Six-month follow-up ultrasound is\nrecommended.\n2. No sonographic abnormality in the left axilla to account for patient's\nsymptoms of pain and swelling.\n\nRECOMMENDATION(S): Follow-up right breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA biopsy clip is noted in the lower central breast. In the central to\nslightly lower outer breast there is a lobulated 0.7 cm mass that was further\nevaluated by ultrasound. Additionally there is a tubular asymmetry in the\nupper right breast anterior depth that appears unchanged compared to ___ both\nalso further evaluated by ultrasound.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the areas concern on\nmammography. At 9 o'clock 3 cm from the nipple there is a 0.8 x 0.6 x 0.5 cm\ncluster of of cyst corresponding to the mass on mammography. In the\nretroareolar region there is one mildly prominent ducts that likely\ncorresponds to the finding on mammography which has been stable since ___ and\nis benign.", + "output": "Cluster of cysts corresponding to the questioned mass on mammography. No\nspecific evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "The breast tissues are fatty with scattered fibroglandular tissue. There are\nstable post treatment changes in the left breast. Scattered areas of\nnodularity are again seen in the right breast, at least one of which was shown\nto represent a cyst in ___. Two biopsy clips are again seen in the upper\nright breast. A vague asymmetry in the upper outer posterior right breast is\nidentified and persisted on additional spot compression imaging. Therefore,\nthis area was further evaluated with ultrasound.\n\nUltrasound of the right breast at 11 o'clock 9 cm from the nipple in the area\nof concern on mammography identifies a 0.6 x 0.3 x 0.7 cm irregular hypoechoic\nmass with a surrounding echogenic halo. This should be viewed with some\nsuspicion and biopsy should be considered. In addition, imaging of the right\naxilla identified a 1.9 cm benign appearing axillary node. No pathologic\nlymphadenopathy is seen.\n\nResults were discussed directly with the patient and two of her daughters as\nwell as with Dr. ___ by phone on ___ at 14:58. It was decided\nto proceed ahead with the core biopsy at this time and the patient will\nfollowup with Dr. ___ the biopsy results in a few days.", + "output": "0.6 x 0.3 x 0.7 cm suspicious mass in the right breast at 11 o'clock for which\nbiopsy should be considered at this time. The patient was scheduled undergo\nultrasound coronal core biopsy following the diagnostic evaluation. Stable\nleft post treatment changes.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "The breast tissues are fatty with scattered fibroglandular tissue. There are\nstable post treatment changes in the left breast. Scattered areas of\nnodularity are again seen in the right breast, at least one of which was shown\nto represent a cyst in ___. Two biopsy clips are again seen in the upper\nright breast. A vague asymmetry in the upper outer posterior right breast is\nidentified and persisted on additional spot compression imaging. Therefore,\nthis area was further evaluated with ultrasound.\n\nUltrasound of the right breast at 11 o'clock 9 cm from the nipple in the area\nof concern on mammography identifies a 0.6 x 0.3 x 0.7 cm irregular hypoechoic\nmass with a surrounding echogenic halo. This should be viewed with some\nsuspicion and biopsy should be considered. In addition, imaging of the right\naxilla identified a 1.9 cm benign appearing axillary node. No pathologic\nlymphadenopathy is seen.\n\nResults were discussed directly with the patient and two of her daughters as\nwell as with Dr. ___ by phone on ___ at 14:58. It was decided\nto proceed ahead with the core biopsy at this time and the patient will\nfollowup with Dr. ___ the biopsy results in a few days.", + "output": "0.6 x 0.3 x 0.7 cm suspicious mass in the right breast at 11 o'clock for which\nbiopsy should be considered at this time. The patient was scheduled undergo\nultrasound coronal core biopsy following the diagnostic evaluation. Stable\nleft post treatment changes.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "At 11 o'clock position, 9 cm from the nipple, there is irregular hypoechoic\nmass with surrounding echogenic halo measuring approximately 0.7 cm\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___ . The procedure was supervised by P. ___,\nM.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. No significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast mass at 11\no'clock position. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Resident / Fellow\nduring the key components of the above procedure and I reviewed and agree with\nthe Resident's / Fellow's findings and dictation." + }, + { + "input": "At 11 o'clock position, 9 cm from the nipple, there is irregular hypoechoic\nmass with surrounding echogenic halo measuring approximately 0.7 cm\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___ . The procedure was supervised by P. ___,\nM.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. No significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast mass at 11\no'clock position. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Resident / Fellow\nduring the key components of the above procedure and I reviewed and agree with\nthe Resident's / Fellow's findings and dictation." + }, + { + "input": "Right breast: Targeted ultrasound of the area of reported palpable concern\nwas performed. No solid or cystic mass is identified. No sonographic\nabnormality is identified in the region of clinical concern.\n\nLeft breast: Targeted ultrasound of the inner left breast in the area of\nround asymmetry on the mammogram. At 9 o'clock, 3 cm from nipple, a 6 mm\nanechoic thin-walled cyst is identified with posterior acoustic enhancement\nand no internal vascularity, corresponding to the nodular asymmetry in the\ninner central left breast on recent mammogram that has been stable since ___.", + "output": "1. No suspicious sonographic findings in the area of reported palpable\nconcern in the right breast. Clinical followup is recommended. Any decision\nto biopsy and final patient disposition should be based on clinical\nassessment.\n\n2. Benign cyst in the left breast.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight breast: There are diffuse punctate calcifications. Multiple\ncircumscribed, benign-appearing masses are unchanged from multiple prior\nexaminations. There is no unexplained architectural distortion or grouped\nmicrocalcifications.\n\nLeft breast: Round and punctate calcifications in the upper outer quadrant of\nthe left breast are stable dating back to ___. Several grouped\ncalcifications in the upper outer left breast represent milk of calcium. \nMultiple masses in the lower inner left breast appear increased in size from\nthe prior examination. No unexplained architectural distortion.\n\nLEFT BREAST ULTRASOUND: Multiple simple cysts are noted in the lower inner\nquadrant of the left breast. A single 2.0 x 1.9 x 1.9 cm complex cyst without\ninternal vascularity or solid component is noted at the 6 o'clock position 7\ncm from the nipple.", + "output": "1. Likely benign calcifications in the upper outer quadrant of the left\nbreast are stable dating back to ___.\n2. A probable benign complex cyst in the lower left breast for which a\nsix-month follow-up ultrasound is recommended to document stability.\n\nRECOMMENDATION(S): Recommend ___ year follow up mammogram to assess for\nstability of left breast calcifications.\n\nRecommend six-month follow-up of a probable benign mass, likely a complex cyst\nin the lower left breast to assess for stability.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight breast: There are diffuse punctate calcifications. Multiple\ncircumscribed, benign-appearing masses are unchanged from multiple prior\nexaminations. There is no unexplained architectural distortion or grouped\nmicrocalcifications.\n\nLeft breast: Round and punctate calcifications in the upper outer quadrant of\nthe left breast are stable dating back to ___. Several grouped\ncalcifications in the upper outer left breast represent milk of calcium. \nMultiple masses in the lower inner left breast appear increased in size from\nthe prior examination. No unexplained architectural distortion.\n\nLEFT BREAST ULTRASOUND: Multiple simple cysts are noted in the lower inner\nquadrant of the left breast. A single 2.0 x 1.9 x 1.9 cm complex cyst without\ninternal vascularity or solid component is noted at the 6 o'clock position 7\ncm from the nipple.", + "output": "1. Likely benign calcifications in the upper outer quadrant of the left\nbreast are stable dating back to ___.\n2. A probable benign complex cyst in the lower left breast for which a\nsix-month follow-up ultrasound is recommended to document stability.\n\nRECOMMENDATION(S): Recommend ___ year follow up mammogram to assess for\nstability of left breast calcifications.\n\nRecommend six-month follow-up of a probable benign mass, likely a complex cyst\nin the lower left breast to assess for stability.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted sonographic examination of the left inferior breast was performed\nwith attention to the area of prior sonographic abnormality. At 6 o'clock,\n6-7 cm from the nipple, there is an 11 x 12 x 8 mm circumscribed oval mass\nwith low level internal echoes, no internal vascularity, and increased through\ntransmission of sound. This likely represents interval decrease in size of\nthe previously seen complicated cyst. 2 other adjacent cysts are seen today,\nin the same region, more anechoic. The larger of these 2 measures 12 mm and\nthe smaller 9 mm.", + "output": "Probably benign left breast lesion at 6 o'clock, 6-7 cm from the nipple,\nlikely representing complicated cyst which appears to have decreased in size\ncompared to ___.\n\nRECOMMENDATION(S): Patient is due for bilateral mammogram in ___. \nLeft breast ultrasound should also be performed at that time for continued\nsurveillance of this probably benign finding.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight breast:\nAgain demonstrated are scattered punctate calcifications throughout the right\nbreast, several with imaging features consistent with milk-of-calcium. Also\nseen are a few small circumscribed masses which have been characterized as\ncysts on multiple prior studies. There is no spiculated mass, concerning\narchitectural distortion, or suspicious grouped microcalcifications.\n\nLeft breast:\nScattered punctate calcifications are also seen throughout the left breast, in\naddition to grouped microcalcifications demonstrated in the upper-outer\nquadrant which have not significantly changed since ___. There is no\ndominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the right breast was performed as the order indicated a\nsmall 0.5 cm mobile lump at 12- 1 o'clock. A complicated cyst measures 2.2 x\n1.4 x 1.9 cm at 12 o'clock 8 cm from the nipple, and 3 additional simple cyst\nidentified at 1 o'clock 6-7 cm from nipple.\n\nTargeted ultrasound of the left breast demonstrates previously noted probable\ncomplicated cyst with low-grade internal echoes without internal vascularity\nmeasuring 1.1 x 0.7 by 1 cm at 6 o'clock 6-7 cm from nipple..", + "output": "1. Calcifications in the upper outer posterior left breast are stable since\n___ and considered benign.\n2. Redemonstration of a stable probable complicated cyst in the at 6 o'clock\nin the left breast, for which a ___ year follow-up is recommended.\n\nRECOMMENDATION(S): ___ year follow-up diagnostic mammogram with targeted left\nbreast ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight breast:\nAgain demonstrated are scattered punctate calcifications throughout the right\nbreast, several with imaging features consistent with milk-of-calcium. Also\nseen are a few small circumscribed masses which have been characterized as\ncysts on multiple prior studies. There is no spiculated mass, concerning\narchitectural distortion, or suspicious grouped microcalcifications.\n\nLeft breast:\nScattered punctate calcifications are also seen throughout the left breast, in\naddition to grouped microcalcifications demonstrated in the upper-outer\nquadrant which have not significantly changed since ___. There is no\ndominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND:\nTargeted ultrasound of the right breast was performed as the order indicated a\nsmall 0.5 cm mobile lump at 12- 1 o'clock. A complicated cyst measures 2.2 x\n1.4 x 1.9 cm at 12 o'clock 8 cm from the nipple, and 3 additional simple cyst\nidentified at 1 o'clock 6-7 cm from nipple.\n\nTargeted ultrasound of the left breast demonstrates previously noted probable\ncomplicated cyst with low-grade internal echoes without internal vascularity\nmeasuring 1.1 x 0.7 by 1 cm at 6 o'clock 6-7 cm from nipple..", + "output": "1. Calcifications in the upper outer posterior left breast are stable since\n___ and considered benign.\n2. Redemonstration of a stable probable complicated cyst in the at 6 o'clock\nin the left breast, for which a ___ year follow-up is recommended.\n\nRECOMMENDATION(S): ___ year follow-up diagnostic mammogram with targeted left\nbreast ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAgain seen are bilateral circumscribed masses previously shown to represent\ncysts in similar to previous exam. Bilateral calcifications are stable\nconsistent with a benign process. There is no suspicious mass, suspicious\ngrouped microcalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Ultrasound was performed of the left breast. At 6 o'clock\n6-7 cm from the nipple there is a 1.0 x 0.7 x 0.7 cm oval circumscribed\nhypoechoic avascular mass not significantly changed compared to ___\nand likely smaller when compared to ___ and consistent with a\nbenign process.", + "output": "1. ___ year stability of left breast mass consistent with a benign process. No\nfurther imaging follow-up is required.\n2. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAgain seen are bilateral circumscribed masses previously shown to represent\ncysts in similar to previous exam. Bilateral calcifications are stable\nconsistent with a benign process. There is no suspicious mass, suspicious\ngrouped microcalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Ultrasound was performed of the left breast. At 6 o'clock\n6-7 cm from the nipple there is a 1.0 x 0.7 x 0.7 cm oval circumscribed\nhypoechoic avascular mass not significantly changed compared to ___\nand likely smaller when compared to ___ and consistent with a\nbenign process.", + "output": "1. ___ year stability of left breast mass consistent with a benign process. No\nfurther imaging follow-up is required.\n2. No specific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nBB markers are visualized overlying the palpable abnormalities of concern\nwhich correspond to mammographic findings consistent with bilateral\ngynecomastia, similar compared to the prior mammograms.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. At the 11 o'clock\nposition approximately 1-2 cm from the nipple within the right breast and 1:00\nposition 1-2 cm from the nipple within the left breast, fibroglandular tissue\nis seen consistent with gynecomastia.", + "output": "Bilateral gynecomastia, as described above. No suspicious abnormality.\n\nRECOMMENDATION(S): Clinical follow-up.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nBB markers are visualized overlying the palpable abnormalities of concern\nwhich correspond to mammographic findings consistent with bilateral\ngynecomastia, similar compared to the prior mammograms.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. At the 11 o'clock\nposition approximately 1-2 cm from the nipple within the right breast and 1:00\nposition 1-2 cm from the nipple within the left breast, fibroglandular tissue\nis seen consistent with gynecomastia.", + "output": "Bilateral gynecomastia, as described above. No suspicious abnormality.\n\nRECOMMENDATION(S): Clinical follow-up.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted left breast ultrasound was performed from 2 o'clock to 5 o'clock, 1-8\ncm from the nipple, in the region of clinical concern. No suspicious cystic\nor solid masses were identified.", + "output": "No sonographic evidence of malignancy.\n\nRECOMMENDATION: Continued clinical followup is recommended. Any decision to\nbiopsy and final patient disposition should be based on clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere is no dominant or spiculated mass, architectural distortion, or\nsuspicious grouped microcalcifications. A few benign-appearing bilateral\ncalcifications are noted.\n\nBREAST ULTRASOUND: Targeted evaluation of the upper-outer left breast in the\narea of clinical concern as directed by the patient was performed. No\nabnormalities are identified. The upper outer right breast was also skin\ngiven the patient's history of pain in this location, and no abnormalities are\nidentified.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Further workup should be based on clinical evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere is no dominant or spiculated mass, architectural distortion, or\nsuspicious grouped microcalcifications. A few benign-appearing bilateral\ncalcifications are noted.\n\nBREAST ULTRASOUND: Targeted evaluation of the upper-outer left breast in the\narea of clinical concern as directed by the patient was performed. No\nabnormalities are identified. The upper outer right breast was also skin\ngiven the patient's history of pain in this location, and no abnormalities are\nidentified.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Further workup should be based on clinical evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nThere is subtle asymmetry persisting in the right upper outer quadrant without\nany discrete dominant mass or distortion seen on spot compression.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned. In the 11 o'clock, 5 cm from the nipple\nthere is a heterogeneous area containing multiple anechoic spaces within it.\nThis is thought to represent a cluster of cysts versus an area of focal\napocrine metaplasia. This measures 0.8 x 0.5 x 0.5 cm and demonstrates some\nperipheral vascularity but no internal vascularity or posterior features. \nThis is thought to correspond to the mammographic asymmetry.", + "output": "Cluster of cysts versus focal apocrine metaplasia in the 11 o'clock right\nbreast for which a 6 month followup with a right diagnostic mammogram and\nultrasound is recommended.\n\nRECOMMENDATION: Six-month followup with the right diagnostic mammogram and\nultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nThere is subtle asymmetry persisting in the right upper outer quadrant without\nany discrete dominant mass or distortion seen on spot compression.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned. In the 11 o'clock, 5 cm from the nipple\nthere is a heterogeneous area containing multiple anechoic spaces within it.\nThis is thought to represent a cluster of cysts versus an area of focal\napocrine metaplasia. This measures 0.8 x 0.5 x 0.5 cm and demonstrates some\nperipheral vascularity but no internal vascularity or posterior features. \nThis is thought to correspond to the mammographic asymmetry.", + "output": "Cluster of cysts versus focal apocrine metaplasia in the 11 o'clock right\nbreast for which a 6 month followup with a right diagnostic mammogram and\nultrasound is recommended.\n\nRECOMMENDATION: Six-month followup with the right diagnostic mammogram and\nultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n Focal right breast asymmetry is again noted and unchanged. There are no\ndeveloping masses or areas of architectural distortion with no suspicious\ncalcifications.\n\nBREAST ULTRASOUND: Targeted examination to the 10 o'clock position shows a\nstable hypoechoic region measure 0.4 x 0.4 x 0.8 cm. This has a somewhat\ntubular contour on radial scanning and appears to represent a portion of a\nnondilated duct. Additional scanning along the same axis shows continuation\nof this structure just inferior and anterior. No convincing cystic areas are\nseen there is no associated vascularity or posterior features.", + "output": "There has been no mammographic change in the appearance of the right breast. \nUltrasound finding may or may not correspond to that noted on mammography but\ndoes not appear to represent an abnormal mass or complex of cysts at this\ntime.\n\nRECOMMENDATION(S): Six-month followup mammogram and targeted ultrasound at\nthe time of left breast screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n Focal right breast asymmetry is again noted and unchanged. There are no\ndeveloping masses or areas of architectural distortion with no suspicious\ncalcifications.\n\nBREAST ULTRASOUND: Targeted examination to the 10 o'clock position shows a\nstable hypoechoic region measure 0.4 x 0.4 x 0.8 cm. This has a somewhat\ntubular contour on radial scanning and appears to represent a portion of a\nnondilated duct. Additional scanning along the same axis shows continuation\nof this structure just inferior and anterior. No convincing cystic areas are\nseen there is no associated vascularity or posterior features.", + "output": "There has been no mammographic change in the appearance of the right breast. \nUltrasound finding may or may not correspond to that noted on mammography but\ndoes not appear to represent an abnormal mass or complex of cysts at this\ntime.\n\nRECOMMENDATION(S): Six-month followup mammogram and targeted ultrasound at\nthe time of left breast screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously seen focal asymmetry in the upper outer right breast is less\nconspicuous on today's examination. This area was further evaluated with\ntargeted breast ultrasound. There is no dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications in either\nbreast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the expected\nlocation of the mammographic finding and the area of previously documented\nfindings on ultrasound at 10 o'clock and 11 o'clock in the right breast. No\nresidual lesion is identified. There are no suspicious solid or cystic\nmasses.", + "output": "Apparent resolution of the probably benign focal asymmetry in the right breast\nand corresponding lesion in the 11 o'clock position, consistent with a benign\nprocess. The patient can return to screening in ___ year.\n\nRECOMMENDATION(S): Return to annual screening in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Preliminary results were sent with the patient to her same-day\nclinical appointment.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously seen focal asymmetry in the upper outer right breast is less\nconspicuous on today's examination. This area was further evaluated with\ntargeted breast ultrasound. There is no dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications in either\nbreast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the expected\nlocation of the mammographic finding and the area of previously documented\nfindings on ultrasound at 10 o'clock and 11 o'clock in the right breast. No\nresidual lesion is identified. There are no suspicious solid or cystic\nmasses.", + "output": "Apparent resolution of the probably benign focal asymmetry in the right breast\nand corresponding lesion in the 11 o'clock position, consistent with a benign\nprocess. The patient can return to screening in ___ year.\n\nRECOMMENDATION(S): Return to annual screening in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Preliminary results were sent with the patient to her same-day\nclinical appointment.\n\nBI-RADS: 2 Benign." + }, + { + "input": "The liver is visualized and is of normal echogenicity. Within the\nright lobe of liver, an area of low echogenicity is identified that measures 8\nmm x 8 mm x 1.2 cm. This has posterior acoustic enhancement and the\nappearances are consistent with a cyst. No other focal liver lesions\nidentified. The gallbladder is identified and is normal with no evidence of\ncholelithiasis. CBD measures 2.2 mm. The pancreas is visualized in the\nmidline and is normal. The aorta is of normal caliber. The right kidney is\nvisualized and measures 9.9 cm in maximum length with normal renal cortical\nthickness. The left kidney is visualized and measures 10.5 cm in maximum\nlength with normal renal cortical thickness. The spleen is identified and\nmeasures 9 cm in maximum length.", + "output": "Area of low echogenicity in right lobe of liver which measures\n1.2 cm in maximum length, the appearances of which are consistent with a cyst.\nNo other focal lesion identified." + }, + { + "input": "There is normal respiratory variation in both common femoral veins. There is\nnormal compressibility and augmentation of both common femoral, superficial\nfemoral, popliteal, posterior tibial, and peroneal veins. No ___ cyst is\nseen.", + "output": "No evidence of deep vein thrombosis in either lower extremity." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 50, 60, and 70 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 24\ncm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 52 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 92 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 57, 59, and 59 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 20\ncm/sec.\nThe ICA/CCA ratio is 0.64.\nThe external carotid artery has peak systolic velocity of 50 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild degree of heterogeneous plaque in the right internal carotid artery\nyielding less than a 40% stenosis.\n\nNo hemodynamically significant plaque or stenosis in the left internal carotid\nartery." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 89.7 cm/s / 18.8 cm/s\nCCA Distal: 86.2 cm/s / 20.5 cm/s\nICA ___: 67.6 cm/s / 15.2 cm/s\nICA Mid: 77.4 cm/s / 24 cm/s\nICA Distal: 63.3 cm/s / 27 cm/s\nECA: 125 cm/s\nVertebral: 45.6 cm/s\n\nICA/CCA Ratio: 0.9\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n Anterior and just distal to the right carotid bifurcation, a prominent 2.9 cm\ncervical lymph node was incidentally noted.\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 92 cm/s / 17 cm/s\nCCA Distal: 81.5 cm/s / 18.2 cm/s\nICA ___: 64.2 cm/s / 17.7 cm/s\nICA Mid: 71.9 cm/s / 23.2 cm/s\nICA Distal: 68 cm/s / 19.3 cm/s\nECA: 110 cm/s\nVertebral: 42.6 cm/s\n\n\nICA/CCA Ratio: 0.88\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 78 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 46, 97, and 110 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 44\ncm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 61 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 62, 67, and 97 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 42\ncm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 71, 63, and 105 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 42 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 45, 45, and 55 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 70 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the bilateral internal carotid arteries." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n2.0 mg Versed and 100 mcg fentanyl throughout the total intra-service time of\n11 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 1.7 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the left chest wall demonstrated a\nsmall collection in the subcutaneous tissues .\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 14 ___ needle was inserted into the fluid collection in the left chest\nwall under ultrasound guidance. No fluid could be aspirated. This collection\nwas injected with 3 cc of normal saline, which was then aspirated and sent for\nmicrobiology.", + "output": "Unsuccessful aspiration of left chest wall subcutaneous collection. However,\nsaline was injected this collection aspirated and sent for microbiology." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nA marker is placed in the area of symptomatology. There is no mammographic\nfinding in this region. A marker clip from a previous biopsy is identified in\nthe posterior slightly lateral slight superior right breast. Additional\nimaging of the upper-outer quadrant were obtained for a possible asymmetry in\nthe lateral breast. There was no significant persistent findings. There is\nno mass or distortion in this area. There is a stable well-circumscribed mass\nin the superior central anterior depth of the right breast.\n\nBREAST ULTRASOUND: Scans of the entire lateral right breast were normal. No\ncystic, solid or shadowing findings were identified.", + "output": "No evidence of left breast malignancy.\n\nProbably benign well-circumscribed mass in the superior central anterior right\nbreast, stable for at least ___ years. Six-month follow-up mammogram is\nrecommended to ensure further stability.\n\n No mammographic or sonographic finding to account for the patient's symptoms\nof pain for which continued clinical follow-up is recommended here\n\nRECOMMENDATION(S): Six-month follow-up 2D/3D right diagnosed mammogram.\n\nNOTIFICATION: findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "The liver shows no evidence of focal lesions or textural abnormality. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The common\nbile duct measures 2 mm. The gallbladder has been surgically removed. Within\nthe gallbladder fossa, echogenic material is likely secondary to postsurgical\nair. No the fluid collection identified. The portal vein is patent. Evaluation\nof the pancreas is somewhat limited, however visualized portions of the\npancreatic body are within normal limits. The spleen measures 10.3 cm and has\nhomogenous echotexture. There is an 11 mm nonobstructive stone in the upper\npole/ interpolar region of the left kidney. The right kidney is normal. The\nright kidney measures 11.8 cm and left kidney measures 14.2 cm. There is no\nintra-abdominal ascites.", + "output": "1. Status post laparoscopic cholecystectomy with postsurgical air seen within\nthe gallbladder fossa, somewhat shadowing the area, but no fluid collection\nidentified. If there is persistent concern for collection, CT can be\nperformed.\n\n2. 11 mm nonobstructive left renal stone." + }, + { + "input": "The gallbladder appears moderately distended and shows evidence of small\nstones and sludge in the dependent position. There is no gallbladder wall\nedema or pericholecystic fluid seen. The common hepatic duct measures 2 mm\nand there is no intrahepatic duct dilatation.\n\nThe size of the gallbladder was compared to the prior scans. Maximal of\nlength and width on today's scan is 7.5 x 3.3 cm, as compared to 8.1 x 3.5 cm\non the prior ultrasound and 8.5 x 3.8 cm on the prior CT.", + "output": "Cholelithiasis. Given the lack of specific ultrasound signs of acute\ncholecystitis, and the slightly smaller ___ of the gallbladder compared\nto outside scans 5 days ago, it was felt that a percutaneous cholecystostomy\nwas not indicated. The positive HIDA scan from ___ reflect\nchronic cholecystitis rather than acute cholecystitis.\n\nRECOMMENDATION(S): Defer percutaneous cholecystostomy procedure in view of\nthe finding stated above.\n\nNOTIFICATION: Findings and recommendations were discussed with Dr. ___ by\ntelephone at 15:45." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA 0.7 cm superficially located circumscribed asymmetry persists in the outer\nbreast. This was further evaluated with ultrasound. Skin calcifications are\nredemonstrated. There is no architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the mammographic area\nof concern. At the 9 o'clock position, approximately 5 cm from the nipple, is\nan oval, circumscribed, hypoechoic mass measuring 0.8 x 0.7 x 0.3 cm,\ncorrelating to the mammographic finding.", + "output": "0.9 cm right breast mass, correlating to the asymmetry seen on mammogram. \nAlthough the features favor a benign mass such as a fibroadenoma, a six-month\nfollow-up ultrasound should be obtained to ensure stability.\n\nRECOMMENDATION(S): A six-month follow-up ultrasound is recommended to ensure\nstability of a right breast mass.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA 0.7 cm superficially located circumscribed asymmetry persists in the outer\nbreast. This was further evaluated with ultrasound. Skin calcifications are\nredemonstrated. There is no architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the mammographic area\nof concern. At the 9 o'clock position, approximately 5 cm from the nipple, is\nan oval, circumscribed, hypoechoic mass measuring 0.8 x 0.7 x 0.3 cm,\ncorrelating to the mammographic finding.", + "output": "0.9 cm right breast mass, correlating to the asymmetry seen on mammogram. \nAlthough the features favor a benign mass such as a fibroadenoma, a six-month\nfollow-up ultrasound should be obtained to ensure stability.\n\nRECOMMENDATION(S): A six-month follow-up ultrasound is recommended to ensure\nstability of a right breast mass.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "1. Redemonstration of acalculous cholecystitis.\n2. Successful drainage and drain placement within the gallbladder.\n3. 70 cc of bilious fluid was removed and sent for microbiology evaluation.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "Tissue density: The breasts are almost entirely fatty. There are no dominant\nmasses, suspicious microcalcifications, or unexplained architectural\ndistortion. The parenchymal pattern is stable, with no significant interval\nchange. The previously known clustered cysts in the right breast and at 6 to\n7 o'clock position, is not evident on mammogram from today. Ultrasound\ncorrelate confirms this finding", + "output": "No evidence of malignancy\n\nRECOMMENDATION: Return to yearly screening mammogram is recommended\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breasts are almost entirely fatty. There are no dominant\nmasses, suspicious microcalcifications, or unexplained architectural\ndistortion. The parenchymal pattern is stable, with no significant interval\nchange. The previously known clustered cysts in the right breast and at 6 to\n7 o'clock position, is not evident on mammogram from today. Ultrasound\ncorrelate confirms this finding", + "output": "No evidence of malignancy\n\nRECOMMENDATION: Return to yearly screening mammogram is recommended\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses were performed with a 16 gauge core biopsy needle.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed during which the patient's hemodynamic parameters were\ncontinuously monitored by an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 75, 59, and 87 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 294 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has significant heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 165, 206, and 106 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 52 cm/sec.\nThe ICA/CCA ratio is 3.1.\nThe external carotid artery has peak systolic velocity of 267 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is less than 40% stenosis within the right internal carotid artery.\n\nThere is 60-69% stenosis within the left internal carotid artery." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nAdditional imaging confirm a circumscribed oval mass in the right upper\ncentral and in the left lower inner quadrant without associated calcifications\nor distortion.\n\nBILATERAL BREAST ULTRASOUND:\n\nRight breast: Targeted us of the right upper central quadrant demonstrates a\ncircumscribed oval anechoic mass in the 11 o'clock 3 cm from the nipple\ncorresponding to the mass seen on the mammogram. This measures 0.4 x 0.4 x\n0.4 cm and demonstrates good through transmission and no internal vascularity\nand is consistent with a simple cyst.\nLeft breast: Targeted ultrasound of the left lower inner quadrant demonstrates\na circumscribed oval anechoic mass in the ___ o'clock 6 cm from the nipple\ncorresponding to the mass seen on the mammogram. This measures 0.4 x 0.2 x\n0.3 cm and demonstrates good through transmission and no internal vascularity\nis consistent with a simple cyst.", + "output": "No evidence of malignancy. Bilateral simple cysts corresponding to the\nasymmetry seen on mammogram.\n\nRECOMMENDATION: Age and risk appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nAdditional imaging confirm a circumscribed oval mass in the right upper\ncentral and in the left lower inner quadrant without associated calcifications\nor distortion.\n\nBILATERAL BREAST ULTRASOUND:\n\nRight breast: Targeted us of the right upper central quadrant demonstrates a\ncircumscribed oval anechoic mass in the 11 o'clock 3 cm from the nipple\ncorresponding to the mass seen on the mammogram. This measures 0.4 x 0.4 x\n0.4 cm and demonstrates good through transmission and no internal vascularity\nand is consistent with a simple cyst.\nLeft breast: Targeted ultrasound of the left lower inner quadrant demonstrates\na circumscribed oval anechoic mass in the ___ o'clock 6 cm from the nipple\ncorresponding to the mass seen on the mammogram. This measures 0.4 x 0.2 x\n0.3 cm and demonstrates good through transmission and no internal vascularity\nis consistent with a simple cyst.", + "output": "No evidence of malignancy. Bilateral simple cysts corresponding to the\nasymmetry seen on mammogram.\n\nRECOMMENDATION: Age and risk appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nIn the slightly outer right subareolar region, along the mid nipple line\nextending to the base of the nipple, there is a 1.5 x 1.0 cm irregular,\nspiculated high-density mass with internal calcifications. The right nipple\nis slightly retracted.\nThe remainder of the right breast is without suspicious dominant mass. There\nis a prominent right axillary lymph node.\n\nThe left breast is without suspicious dominant mass, architectural distortion\nor suspicious grouped calcification.\n\nThe technologist noted that blood and pus were expressed from the right nipple\nduring mammographic compression.\n\nRIGHT BREAST ULTRASOUND: In the right retroareolar region at 9 o'clock, 0 cm\nfrom the nipple, extending into the base of the nipple, there is an 1.5 x 0.9\nx 1.1 cm irregular, hypoechoic, taller than wide, mass with dominant\nvascularity. This corresponds to the mass seen on mammography and is\nconcerning for carcinoma.\n\nSeveral right axillary lymph nodes were scanned and one appears slightly\nprominent with cortical thickness measuring up to 0.3 cm.", + "output": "1.5 cm spiculated, irregular mass in the right retroareolar region at 9\no'clock is highly suspicious for malignancy. Ultrasound core biopsy with clip\nplacement is recommended.\n\n1 borderline right axillary lymph node may be attributable to history of\nlymphoproliferative disorder, and HIV status.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the right retroareolar\nbreast mass.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. Although he was offered a biopsy tomorrow morning,\n___, he chose ___ at 12:45 for a biopsy appointment.\n\nFindings were also communicated via e-mail to Dr. ___ Dr. ___\nrequested by the patient) by Dr. ___.\n\n The impression and recommendation above was entered by Dr. ___\non ___ at 16:56 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nIn the slightly outer right subareolar region, along the mid nipple line\nextending to the base of the nipple, there is a 1.5 x 1.0 cm irregular,\nspiculated high-density mass with internal calcifications. The right nipple\nis slightly retracted.\nThe remainder of the right breast is without suspicious dominant mass. There\nis a prominent right axillary lymph node.\n\nThe left breast is without suspicious dominant mass, architectural distortion\nor suspicious grouped calcification.\n\nThe technologist noted that blood and pus were expressed from the right nipple\nduring mammographic compression.\n\nRIGHT BREAST ULTRASOUND: In the right retroareolar region at 9 o'clock, 0 cm\nfrom the nipple, extending into the base of the nipple, there is an 1.5 x 0.9\nx 1.1 cm irregular, hypoechoic, taller than wide, mass with dominant\nvascularity. This corresponds to the mass seen on mammography and is\nconcerning for carcinoma.\n\nSeveral right axillary lymph nodes were scanned and one appears slightly\nprominent with cortical thickness measuring up to 0.3 cm.", + "output": "1.5 cm spiculated, irregular mass in the right retroareolar region at 9\no'clock is highly suspicious for malignancy. Ultrasound core biopsy with clip\nplacement is recommended.\n\n1 borderline right axillary lymph node may be attributable to history of\nlymphoproliferative disorder, and HIV status.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the right retroareolar\nbreast mass.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. Although he was offered a biopsy tomorrow morning,\n___, he chose ___ at 12:45 for a biopsy appointment.\n\nFindings were also communicated via e-mail to Dr. ___ Dr. ___\nrequested by the patient) by Dr. ___.\n\n The impression and recommendation above was entered by Dr. ___\non ___ at 16:56 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "In the right breast retroareolar region at 9 o'clock, 1 cm from the nipple,\nagain seen is a 1.5 x 1.0 x 1.1 cm irregular hypoechoic mass with dominant\nvascularity and shadowing, which was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, M.D.,. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: Single CC view confirm appropriate clip placement\nin the retroareolar mass.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast retroareolar region at 9 o'clock, 1 cm from the nipple,\nagain seen is a 1.5 x 1.0 x 1.1 cm irregular hypoechoic mass with dominant\nvascularity and shadowing, which was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, M.D.,. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: Single CC view confirm appropriate clip placement\nin the retroareolar mass.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "The recently biopsied hypoechoic mass is essentially unchanged measuring\napproximately 1.7 x 1.1 x 1.2 cm. Contiguous to this mass, however, is a\nvague ill-defined hypoechoic edematous area measuring 1 cm in maximal\ndimension which may represent an area of hematoma related to recent biopsy,\nalthough infection cannot be entirely excluded. No drainable collection is\nappreciated. Clinical correlation would be recommended. Further imaging at\nthis time should be based on the clinical assessment.", + "output": "Essentially unchanged stable recently biopsy benign mass in the right breast\nwith probable adjacent hematoma, although infection cannot be entirely\nexcluded. Clinical management is recommended at this time. Further imaging\nat this time should be based on the clinical assessment.\n\nRECOMMENDATION: Clinical followup.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nIncreased asymmetry retroareolar right breast which contains ribbon biopsy\nclip. There is a new partially obscured mass adjacent to the asymmetry at the\n9:00 position anterior depth which corresponds to area of concern as denoted\nby skin marker. There is no unexplained architectural distortion or\nsuspicious grouped microcalcifications in the right breast. Prominent right\naxillary lymph nodes are identified measuring up to 1.3 cm. There is no\nabnormality identified in the left breast.\n\nBREAST ULTRASOUND: At the 8 to 9:00 position right breast 0-2 cm from the\nnipple there is a bilobed complex fluid collection/cystic mass corresponding\nto Findings on mammogram which has demonstrated interval enlargement compared\nto ultrasounds from ___. The more lateral component which corresponds to\npalpable abnormality measures 1.6 x 1.4 x 1.0 cm and the more central\ncomponent measures 1.4 x 1.5 x 1.1 cm. Together these measure approximately\n3.4 cm.", + "output": "Interval enlargement complex fluid collection/cystic mass ___ position\nright breast extending from 0-2 cm from the nipple. This was previously\nbiopsied demonstrating mixed inflammatory/infectious process. Findings today\ncould represent worsening of original process or superinfection. This\ncollection may be amenable to ultrasound-guided aspiration which is scheduled\nfor the same day.\n\nRECOMMENDATION(S): As above.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nIncreased asymmetry retroareolar right breast which contains ribbon biopsy\nclip. There is a new partially obscured mass adjacent to the asymmetry at the\n9:00 position anterior depth which corresponds to area of concern as denoted\nby skin marker. There is no unexplained architectural distortion or\nsuspicious grouped microcalcifications in the right breast. Prominent right\naxillary lymph nodes are identified measuring up to 1.3 cm. There is no\nabnormality identified in the left breast.\n\nBREAST ULTRASOUND: At the 8 to 9:00 position right breast 0-2 cm from the\nnipple there is a bilobed complex fluid collection/cystic mass corresponding\nto Findings on mammogram which has demonstrated interval enlargement compared\nto ultrasounds from ___. The more lateral component which corresponds to\npalpable abnormality measures 1.6 x 1.4 x 1.0 cm and the more central\ncomponent measures 1.4 x 1.5 x 1.1 cm. Together these measure approximately\n3.4 cm.", + "output": "Interval enlargement complex fluid collection/cystic mass ___ position\nright breast extending from 0-2 cm from the nipple. This was previously\nbiopsied demonstrating mixed inflammatory/infectious process. Findings today\ncould represent worsening of original process or superinfection. This\ncollection may be amenable to ultrasound-guided aspiration which is scheduled\nfor the same day.\n\nRECOMMENDATION(S): As above.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Right breast abscess at ___ o'clock 0-2 cm from the nipple.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D.. T\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the right breast abscess\nand ___ cysts cc of pus was aspirated and sent to microbiology. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast abscess sent to microbiology.", + "output": "Technically successful US-guided aspiration of the right breast abscess\n\nFindings reviewed with the patient at the completion of the aspiration and\ncommunicated to ___.\n\nStandard post care instructions were provided to the patient." + }, + { + "input": "Targeted sonography of the right breast at 9 o'clock 2 cm from nipple\ndemonstrated a very small complex fluid collection extending to the skin\nmeasuring 1.2 x 0.8 x 2.3 cm. Given the small size and the fact that it is\nopen to the skin an actively draining aspiration was deferred today.", + "output": "Small comp fluid collection, open to the skin identified. Drainage was\ndeferred at this time. The patient is being seen in BreastCare Center today\nfor further evaluation.\n\nRECOMMENDATION(S): Continued clinical follow-up is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Transverse and sagittal images were obtained of the superficial tissues of the\npenis demonstrate no discrete fluid collection.", + "output": "Penile ultrasound demonstrates no discrete fluid collection." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 3.5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 2.4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient's proxy (son) via telephone and informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 2.5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.5 L of clear, straw-colored fluid were removed." + }, + { + "input": "Tissue density: The breast tissue is extremely dense which lowers the\nsensitivity of mammography. A BB was placed over the palpable area in the left\nupper outer breast. An area of increased density is noted underlying the\npalpable area however a discrete mass is not appreciated on the mammogram.\nThere are no suspicious clustered microcalcifications or areas of\narchitectural distortion.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound left breast is performed. The\npalpable areas at 12 o'clock. Underlying the palpable area at 12 o'clock 3 cm\nfrom the nipple is a irregular hypoechoic mass measuring 0.9 x 0.9 x 1.2 cm\nwhich has central vascularity. Immediately posterior to this is another\nirregular mass measuring 0.5 x 0.5 x 0.4 cm. 2 cms lateral to this at 1:30- 2\no'clock 3 cm from the nipple is another irregular hypoechoic mass measuring\n1.5 x 1.2 x 1.5 cm. The entire area of involvement including the 2 masses is\n4.6 cm.\n\nLeft axillary ultrasound: The left axilla was scanned and a normal-appearing\nleft axillary lymph node noted. No abnormal axillary lymphadenopathy seen.", + "output": "Three suspicious masses in the left breast between 12 and 2 o'clock,\nunderlying palpable area. Ultrasound-guided core biopsy of the 2 dominant\nmasses recommended. Patient is scheduled later today for the biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Findings communicated to ___ NP at and Dr. ___ office at the\ntime of interpretation of the study. Findings also a emailed to ___.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: The breast tissue is extremely dense which lowers the\nsensitivity of mammography. A BB was placed over the palpable area in the left\nupper outer breast. An area of increased density is noted underlying the\npalpable area however a discrete mass is not appreciated on the mammogram.\nThere are no suspicious clustered microcalcifications or areas of\narchitectural distortion.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound left breast is performed. The\npalpable areas at 12 o'clock. Underlying the palpable area at 12 o'clock 3 cm\nfrom the nipple is a irregular hypoechoic mass measuring 0.9 x 0.9 x 1.2 cm\nwhich has central vascularity. Immediately posterior to this is another\nirregular mass measuring 0.5 x 0.5 x 0.4 cm. 2 cms lateral to this at 1:30- 2\no'clock 3 cm from the nipple is another irregular hypoechoic mass measuring\n1.5 x 1.2 x 1.5 cm. The entire area of involvement including the 2 masses is\n4.6 cm.\n\nLeft axillary ultrasound: The left axilla was scanned and a normal-appearing\nleft axillary lymph node noted. No abnormal axillary lymphadenopathy seen.", + "output": "Three suspicious masses in the left breast between 12 and 2 o'clock,\nunderlying palpable area. Ultrasound-guided core biopsy of the 2 dominant\nmasses recommended. Patient is scheduled later today for the biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Findings communicated to ___ NP at and Dr. ___ office at the\ntime of interpretation of the study. Findings also a emailed to ___.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Again seen are two dominant masses in the upper outer left breast, located at\n___ o'clock and at 2 o'clock position\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___, M.D.. The procedure was supervised\nby ___, M.D.(Attending).\n\nDescription:\nLESION 1: Left breast ___ o'clock 3 cm from the nipple. Using ultrasound\nguidance, aseptic technique and local anesthesia, a 13-gaugecoaxial needle was\nplaced adjacent to the lesion and 5 cores were obtained using a 14-gauge Bard\nspring-loaded biopsy device. Next, a percutaneous ribbon shaped clip was\ndeployed under ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nLESION 2: Left breast ___ o'clock 3 cm from the nipple. Using ultrasound\nguidance, aseptic technique and local anesthesia, a 13-gaugecoaxial needle\nwas placed adjacent to the lesion and 4 cores were obtained using a 14-gauge\nBard spring-loaded biopsy device. Next, a percutaneous Hydromark clip was\ndeployed under ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 3 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof both clips.", + "output": "Technically successful US-guided core biopsy of two left breast lesions. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident / Fellow\nduring the key components of the above procedure and I reviewed and agree with\nthe Resident's / Fellow's findings and dictation." + }, + { + "input": "Again seen are two dominant masses in the upper outer left breast, located at\n___ o'clock and at 2 o'clock position\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___, M.D.. The procedure was supervised\nby ___, M.D.(Attending).\n\nDescription:\nLESION 1: Left breast ___ o'clock 3 cm from the nipple. Using ultrasound\nguidance, aseptic technique and local anesthesia, a 13-gaugecoaxial needle was\nplaced adjacent to the lesion and 5 cores were obtained using a 14-gauge Bard\nspring-loaded biopsy device. Next, a percutaneous ribbon shaped clip was\ndeployed under ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nLESION 2: Left breast ___ o'clock 3 cm from the nipple. Using ultrasound\nguidance, aseptic technique and local anesthesia, a 13-gaugecoaxial needle\nwas placed adjacent to the lesion and 4 cores were obtained using a 14-gauge\nBard spring-loaded biopsy device. Next, a percutaneous Hydromark clip was\ndeployed under ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 3 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof both clips.", + "output": "Technically successful US-guided core biopsy of two left breast lesions. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident / Fellow\nduring the key components of the above procedure and I reviewed and agree with\nthe Resident's / Fellow's findings and dictation." + }, + { + "input": "Tissue density: The breast tissue is almost entirely fatty.\n\nPlease note there is limitation for positioning the patient during mammography\ndue to wheelchair. Limited visualization of the axillae.\n\nFINDING\n\nThere are no new dominant masses, suspicious grouped calcifications, or\nunexplained architectural distortion. Stable postoperative changes are re-\ndemonstrated in the upper outer right breast middle third.\n\nRIGHT BREAST ULTRASOUND: There is a 0.5 x 0.6 x 0.2 cm, well-circumscribed\noval solid mass at ___, 5 cm from the nipple in the right breast\nwhich likely represent a fibroadenoma, unchanged when compared to previous\nultrasound from ___. No other sonographic abnormalities were\nidentified. Specifically no masses were seen at 12 o'clock position.", + "output": "Stable solid mass in the right breast at ___, 5 cm from the nipple,\nmost likely fibroadenoma.\n\nRECOMMENDATION: ___ year followup mammogram on ultrasound is recommended\n\nNOTIFICATION: Findings reviewed with the patient and her sister at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: The breast tissue is almost entirely fatty.\n\nPlease note there is limitation for positioning the patient during mammography\ndue to wheelchair. Limited visualization of the axillae.\n\nFINDING\n\nThere are no new dominant masses, suspicious grouped calcifications, or\nunexplained architectural distortion. Stable postoperative changes are re-\ndemonstrated in the upper outer right breast middle third.\n\nRIGHT BREAST ULTRASOUND: There is a 0.5 x 0.6 x 0.2 cm, well-circumscribed\noval solid mass at ___, 5 cm from the nipple in the right breast\nwhich likely represent a fibroadenoma, unchanged when compared to previous\nultrasound from ___. No other sonographic abnormalities were\nidentified. Specifically no masses were seen at 12 o'clock position.", + "output": "Stable solid mass in the right breast at ___, 5 cm from the nipple,\nmost likely fibroadenoma.\n\nRECOMMENDATION: ___ year followup mammogram on ultrasound is recommended\n\nNOTIFICATION: Findings reviewed with the patient and her sister at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM:\nTissue density: A - The breast tissue is almost entirely fatty.\nThe patient is in a wheelchair, limiting breast positioning, and the axilla\ncould not be included on the MLO views bilaterally. An 8 mm circumscribed\noval mass in the anterior depth upper outer right breast as well as an\nasymmetry in the mid depth slightly upper outer right breast are unchanged\nsince ___. An additional 4 mm mass in the upper outer right\nbreast is also stable, likely an intramammary lymph node. There is no new or\nspiculated mass, suspicious grouped microcalcifications or unexplained\narchitectural distortion in either breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at 11:30, 5\ncm from the nipple demonstrates a 0.8 x 0.3 x 0.7 cm oval, circumscribed,\nparallel hypoechoic mass without internal vascularity or posterior features,\nunchanged since ___ when it was 0.8 x 0.3 x 0.7 cm. No\nadditional solid or cystic mass is seen, specifically at 12 o'clock.\nUltrasound of the bilateral axillae demonstrates no suspicious mass or\nabnormal lymph node.", + "output": "___ years stability of an 8 mm right breast mass, most likely a fibroadenoma.\n\nRECOMMENDATION(S): Diagnostic mammogram and ultrasound in ___ year.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient and\nher sister who agree with the plan. She was given information to schedule her\nfollow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM:\nTissue density: A - The breast tissue is almost entirely fatty.\nThe patient is in a wheelchair, limiting breast positioning, and the axilla\ncould not be included on the MLO views bilaterally. An 8 mm circumscribed\noval mass in the anterior depth upper outer right breast as well as an\nasymmetry in the mid depth slightly upper outer right breast are unchanged\nsince ___. An additional 4 mm mass in the upper outer right\nbreast is also stable, likely an intramammary lymph node. There is no new or\nspiculated mass, suspicious grouped microcalcifications or unexplained\narchitectural distortion in either breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at 11:30, 5\ncm from the nipple demonstrates a 0.8 x 0.3 x 0.7 cm oval, circumscribed,\nparallel hypoechoic mass without internal vascularity or posterior features,\nunchanged since ___ when it was 0.8 x 0.3 x 0.7 cm. No\nadditional solid or cystic mass is seen, specifically at 12 o'clock.\nUltrasound of the bilateral axillae demonstrates no suspicious mass or\nabnormal lymph node.", + "output": "___ years stability of an 8 mm right breast mass, most likely a fibroadenoma.\n\nRECOMMENDATION(S): Diagnostic mammogram and ultrasound in ___ year.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient and\nher sister who agree with the plan. She was given information to schedule her\nfollow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe left upper outer quadrant and lateral breast is without any asymmetry,\nmass or suspicious grouped calcifications. The prior area was likely related\nto overlapping glandular tissue. There are no suspicious calcifications.\n\nThere is an oval 7 x 5 mm circumscribed mass in the medial left breast at\nposterior depth, corresponding to the 8 o'clock lesion seen on same date\nultrasound.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 8 o'clock 2-3 cm\nfrom the nipple demonstrates an oval 6 x 3 x 6 mm circumscribed hypoechoic\nmass in the posterior parenchyma without dominant vascularity or significant\nposterior features. This has the appearance of a cyst.", + "output": "No specific evidence of malignancy. 6 mm left breast cyst.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRIGHT BREAST: There is no dominant mass, architectural distortion or\nsuspicious grouped microcalcifications.\n\nLEFT BREAST: A single low-density well-circumscribed mass is seen in the\ninferior left breast on lateral view only, measuring approximately 6 mm. This\nwas further evaluated on same day targeted left breast ultrasound. Otherwise,\nthere is no dominant mass, architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed in the\narea of pain as indicated by the patient at the ___ o'clock position, 6-9 cm\nfrom the nipple. No discrete suspicious solid or cystic masses were\nidentified.\n\nLEFT BREAST ULTRASOUND: Targeted left breast ultrasound assessing the ___\no'clock position ___ and 6-9 cm away from the nipple. A 0.5 x 0.1 x 0.3 cm\ntiny anechoic mass seen at the ___ o'clock position 4 cm from the nipple is\nthought to correspond to the left breast mass on same day mammogram and is\nmost consistent with a simple cyst. Otherwise, no discrete suspicious solid\nor cystic masses are identified.", + "output": "1. Benign-appearing left breast simple cyst.\n2. No specific evidence of malignancy in either breast. Clinical follow-up is\nrecommended for breast pain.\n\nRECOMMENDATION(S): Age and risk appropriate screening. Clinical follow-up.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no new suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. Subtle bilateral changes of reduction\nmammoplasty are noted. There is a subtle density, adjacent to the radiopaque\nmarker indicating the area of palpable concern, in the subareolar right\nbreast. Additionally, scattered punctate calcifications are noted in the\nsubareolar right breast. There is a 3 mm group of punctate calcifications in\nthe lower central left breast at middle depth. There is an asymmetric breast\ntissue in the upper outer subareolar left breast, likely representing normal\nglandular breast tissue. Further evaluation with targeted left breast\nultrasound was performed for confirmation.\n\nBREAST ULTRASOUND: In the right breast at ___ o'clock, 2 cm from the\nnipple, at the site of the palpable lump and focal tenderness, there is a 1.5\nx 1.0 x 1.4 cm heterogeneous fluid collection without internal blood flow,\nconsistent with an abscess. No suspicious cystic or solid masses or foreign\nbodies are seen. Targeted ultrasound of the subareolar left breast in the\narea of asymmetric breast tissue reveals normal glandular breast tissue\nwithout any suspicious cystic or solid masses.", + "output": "1. Right breast abscess, for which needle aspiration is requested, which is\nperformed later on the same date and dictated separately. Followup right\nbreast ultrasound to document complete resolution is recommended in 6 months. \nNo evidence of foreign body in the subareolar right breast.\n\n2. Probably benign calcifications in the lower central left breast. Followup\nmammogram of the left breast in 6 months to document stability of\ncalcifications is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided aspiration of the right breast abscess. \nFollowup right breast ultrasound in 6 months to document complete resolution. \nProbably benign calcifications in the left breast. Follow-up mammogram of the\nleft breast to document stability in 6 months is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "AT ___ O'CLOCK 2 CM FROM THE NIPPLE THERE IS RE- DEMONSTRATION OF A 1.4 X 1.4\nX 1.7 CM COLLECTION. THIS DOES NOT APPEAR SIGNIFICANTLY DIFFERENT FROM THE ___ STUDY.", + "output": "RIGHT BREAST COLLECTION NOT SIGNIFICANTLY CHANGED FROM ___.\n\nRECOMMENDATION: ULTRASOUND-GUIDED ASPIRATION WILL BE PERFORMED.\n\nNOTIFICATION: THE PATIENT AND ___ ARE AWARE.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is re- demonstration of a right breast collection at ___ o'clock 2 cm\nfrom the nipple measuring up to 2.4 cm.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the lesion and 1 cc of\npurulent fluid was aspirated. The fluid was sent to microbiology. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: 1 cc of purulent fluid was sent to microbiology\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast abscess", + "output": "Technically successful US-guided aspiration of the right breast abscess.\n\nFindings reviewed with the patient at the completion of the aspiration.\n\nStandard post care instructions were provided to the patient.\n\nRECOMMENDATION(S): Clinical followup. The patient is due to return in 6\nmonths for a mammogram to evaluate calcifications in the left breast." + }, + { + "input": "Grayscale and power Doppler images were obtained in the right breast at 11\no'clock 0-2 cm from the nipple, at the site of tenderness, as indicated by the\npatient. In this region, there is a 1.5 x 0.6 x 1.3 cm irregular hypoechoic\nregion with mild vascularity, compatible with postsurgical changes and\ninflammatory phlegmon. Of note, there is no associated drainable fluid\ncollection.", + "output": "Postsurgical and inflammatory/phlegmonous changes measuring approximately 1.5\ncm at the right breast site of incision at 11 o'clock, 0-2 cm from the nipple.\n\nRECOMMENDATION(S): There is no fluid collection for ultrasound guided\naspiration/drainage. Clinical followup with Dr. ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Dr. ___ the above findings via telephone to Dr.\n___ at 15:40 on ___, 2 min after discovery. Per Dr. ___,\n___ patient ___ be started on antibiotics.\n\nBI-RADS: 2 Benign." + }, + { + "input": "At 12 o'clock, 2 cm from the nipple in the right breast, in the area of\nconcern and tenderness, again seen is a small area of irregular, hypoechoic\nregion with mild vascularity, compatible with postsurgical changes and\ninflammatory phlegmon, similar to ___. There is no drainable\ncollection.", + "output": "Postsurgical and inflammatory changes at the right breast, similar to ___. No drainable fluid collection. Recommend continued follow-up in breast\ncare clinic." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast. A BB marker overlies the right upper\nouter breast. A biopsy marker is within the left upper outer breast. \nParenchymal pattern compatible with reduction mammoplasty.\n\nBREAST ULTRASOUND: Targeted breast ultrasound was performed in the right\nupper outer breast in the area of palpable abnormality and reported pain at\n___ o'clock. No discrete suspicious solid or cystic masses were identified. \nAdditionally, no abnormal lymphadenopathy was identified in the right axilla.", + "output": "No mammographic evidence of malignancy in either breast. Specifically, no\nmammographic or sonographic evidence of malignancy in the right upper outer\nbreast.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Corresponding to the mammographic finding in the subareolar region is a simple\ncyst at 9 o'clock measuring 0.3 x 0.3 x 0.4 cm. The patient is on Synthroid\nwhich can account for this finding.", + "output": "Simple cyst in the left breast corresponding to the mammographic finding.\n\nRECOMMENDATION(S): Risk and age based screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nAn 8 mm oval circumscribed mass with a coarse calcification in the anterior\ndepth upper outer right breast is fluctuating on multiple prior mammograms\ndating back to ___, suggestive of a benign process. This is further\nevaluated with ultrasound. There is no spiculated mass, suspicious grouped\nmicrocalcifications or unexplained architectural distortion in the right\nbreast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the upper-outer right breast\nat the site of mammographic finding was performed. At 11 o'clock, 6 cm from\nthe nipple, there is an 8 x 3 x 5 mm oval, circumscribed, anechoic mass with\nan internal echogenic focus, consistent with a calcification. This has the\nappearance of a simple cyst and nicely corresponds to the 8 mm mammographic\nmass with a coarse calcification. No suspicious solid or cystic mass is\nidentified.", + "output": "No specific evidence of malignancy in the right breast. Fluctuating right\nbreast mass with coarse calcification corresponds to a simple cyst at 11\no'clock. No specific imaging follow-up is required.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her annual\nscreening mammogram. .\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breast tissue is heterogeneously dense which may obscure\ndetection of small masses. A BB marker is placed in the left posterior\naxillary breast tissue over the palpable abnormality. No mammographic\nabnormality is present in the palpable area.\nTwo biopsy clips are present in the inner upper breast. There is no dominant\nmass, suspicious calcifications or architectural distortion in the left\nbreast.\n\nIn the right lower inner breast there is a new partially circumscribed mass\nmeasuring 1.3 cm for which ultrasound was performed. Three biopsy clips are\npresent in the right breast. There are no suspicious calcifications or\nunexplained architectural distortion.\n\nBILATERAL BREAST ULTRASOUND:\n\nLEFT BREAST ULTRASOUND: Ultrasound was performed at 11 o'clock 12 cm from the\nnipple in the area of the patient's palpable concern. Normal breast tissue is\npresent and no solid or cystic mass is identified.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the lower inner\nright breast in the area of the mammographic abnormality. There is a solid\nhypoechoic mass with irregular angular margins at 6 o'clock 7 cm from the\nnipple measuring 1.3 x 1.1 x 0.9 cm without significant internal vascularity\nor posterior features. Note that some of the ultrasound images are incorrectly\nlabeled 5 o'clock 5 cm from the nipple. This mass seen on ultrasound\ncorresponds to the mass seen on the mammogram.\n\nUltrasound of the right axilla and right internal mammary chain demonstrates\nno lymphadenopathy.", + "output": "1. 1.3 cm mass in the right breast at 6 o'clock corresponding to the new\nmammographic abnormality which is concerning for malignancy. Ultrasound-guided\ncore biopsy is recommended. Patient is amenable to biopsy which will be\nperformed later today. No axillary lymphadenopathy\n2. 3. Normal breast tissue in the left upper breast in the area of the\npatient's palpable concern. Recommend clinical correlation for need for biopsy\nas the patient is scheduled for an MRI in ___ at which time the left\nupper breast can be further evaluated.\n\nRECOMMENDATION: Ultrasound-guided biopsy of the right breast mass. This will\nbe performed later today.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "In the right breast at 6 o'clock 7 cm from the nipple there is an irregular\nhypoechoic mass measuring 1.2 x 1.2 x 1.1 cm for which biopsy is recommended.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D., ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine and\nbicarbonate for local anesthesia, a 13-gaugecoaxial needle was placed adjacent\nto the lesion and using a 14-gauge Bard spring-loaded biopsy device, 5 cores\nwere obtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine and bicarbonate\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement the lower inner breast within the mass.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast at 6 o'clock 7 cm from the nipple there is an irregular\nhypoechoic mass measuring 1.2 x 1.2 x 1.1 cm for which biopsy is recommended.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D., ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine and\nbicarbonate for local anesthesia, a 13-gaugecoaxial needle was placed adjacent\nto the lesion and using a 14-gauge Bard spring-loaded biopsy device, 5 cores\nwere obtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine and bicarbonate\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement the lower inner breast within the mass.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "There is a complex fluid collection surrounding much of the left breast\nimplant thickest at the 9 o'clock position where it measures up to 1.5 cm\n(image 3). There thick internal septations and debris within the collection.\nThere is no dominant vascularity.", + "output": "Complex fluid collection surrounding much of the left breast implant. At the\ntime of this dictation the collection has already been drained by the body\ninterventionalist.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nSee above." + }, + { + "input": "Targeted ultrasound of the left breast again demonstrates a complex fluid\ncollection surrounding much of the left breast tissue expander, thickest in\nthe ___ o'clock position in the lower inner left breast measuring up to 1.9 cm\ndeep. Within the fluid collection are thick internal septations and debris.\nThere is no dominant vascularity.", + "output": "Complex fluid collection surrounding much of the left breast tissue expander.\n\nThe patient was originally scheduled for same day ultrasound guided aspiration\nof the fluid collection; however, the procedure was aborted as the referring\nphysician preferred placement of a drainage catheter, which will be scheduled\nat a later time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Preprocedural scanning of the left breast demonstrates a multi-septated fluid\ncollection overlying tissue expander as seen on prior diagnostic ultrasound\nexaminations.", + "output": "Successful US-guided placement of ___ pigtail catheter into the left\nbreast collection consistent with a seroma. Sample was sent for microbiology\nevaluation. 85ml of serosanguineous fluid aspirated." + }, + { + "input": "At 11 o'clock 3 cm from the nipple, at the palpable lump, there is an\nirregular bilobed fluid collection with internal echogenicity and associated\ninflammation measuring 3.1 x 1.3 x 2.2 cm. There is some increased\nechogenicity of the surrounding tissue consistent with inflammation.", + "output": "3.1 cm probable left breast abscess.\n\nRECOMMENDATION(S): Abscess drainage.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given an appointment for 10:30 for abscess\ndrainage.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the left breast at 11 o'clock 3 cm from the nipple is an irregular\nheterogeneously dense mass measuring 2.2 x 2.6 x 1.5 cm.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___.\n___, M.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 in then a 16 gauge needle was advanced into the mass\nin an attempt to aspirate this mass. However, no fluid was aspirated. \nTherefore, a 13-gaugecoaxial needle was placed adjacent to the lesion and\nusing a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Several tissue samples were placed in formalin and sent to\npathology. Several tissue samples were placed in a sterile cup with saline\nand sent to microbiology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending. The patient expects to hear the pathology results from the\nreferring provider ___ ___ business days. Standard post care instructions were\nprovided to the patient.\n\n As the Attending radiologist, I personally supervised the Nurse Practitioner\nduring the key components of the above procedure and agree with their findings\nand dictation." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nNo architectural distortion, suspicious mass, or clustered microcalcifications\nare present\n\nBREAST ULTRASOUND: Left targeted the architectural appearance of the breast\nhas reverted to normal. There is no evidence of residual fluid collection or\ncicatrization in the area of the prior left breast abscess", + "output": "Normal negative\n\nRECOMMENDATION(S): Routine screening mammogram at age ___\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography. Previously seen two areas of architectural\ndistortion in the upper central to slightly inner right breast persists on\nadditional images, and are suspicious. Targeted ultrasound was performed. \nThere are no grouped suspicious microcalcifications. There are persistent\nmultiple circumscribed masses in the right breast, in keeping with benign\nfindings and most likely cysts as seen on prior studies.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast 1 o'clock 8 cm from\nthe nipple, corresponding to the area of mammographic concern, demonstrates an\nirregular, hypoechoic spiculated mass oriented taller than wide measuring 1.5\nx 1.6 x 1.4 cm with posterior acoustic shadowing. There is no significant\ninternal vascularity.\n\nTargeted ultrasound of the right breast at 1 o'clock 2 cm from the nipple,\ncorresponding to the area of mammographic concern, demonstrates an irregular,\nhypoechoic spiculated mass oriented taller than wide measuring 1.4 x 2.2 x 1.1\ncm. There is no significant internal vascularity.\n\nSonographic evaluation of the right axilla demonstrates no lymphadenopathy.", + "output": "Two spiculated masses in the right breast at 1 o'clock are suspicious.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the more anterior\nmass at 1 o'clock 2 cm from the nipple is recommended. Management of the\nadditional mass at 1 o'clock 8 cm from nipple will be determined based on\npathology.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. An ultrasound-guided core needle biopsy was scheduled\nand performed upon completion of diagnostic imaging.\n\nThese findings were directly communicated to the patient's physician, ___\n___, via e-mail and telephone at 16:40 on ___ by Dr. ___\n___ with confirmation.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "An irregular, hypoechoic, spiculated mass is again seen within the right\nbreast at 1 o'clock, 2 cm from the nipple, which was selected for core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___ (radiology resident). The procedure was\nsupervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "An irregular, hypoechoic, spiculated mass is again seen within the right\nbreast at 1 o'clock, 2 cm from the nipple, which was selected for core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___ (radiology resident). The procedure was\nsupervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted ultrasound of the left breast 3:30 o'clock 5 cm from the nipple,\ncorresponding to the area of clinical concern on the requisition, demonstrates\nan anechoic avascular, circumscribed structure measuring 20 x 13 x 20 mm. \nThis finding is consistent with a simple cyst. Additional simple cysts are\nidentified at 4 o'clock 4 cm from the nipple measuring up to 8 mm.", + "output": "Left breast simple cyst at3:30 o'clock corresponds to the area of clinical\nconcern as indicated on the requisition.\n\nRECOMMENDATION(S): 1. No further follow-up of the left breast simple cyst at\n3:30 o'clock is indicated at this time.\n2. Continued management of the patient's known right breast cancer is\nrecommended as per surgical and oncological recommendations.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Right radial artery: Vessel caliber smooth regular. There is filling of the\nradial artery retrograde filling into the brachial artery. There is filling\ninto the ulnar artery, anterior, and posterior interosseous arteries. No\nevidence of vasospasm or occlusion.\n\nLeft common carotid artery: The branches of the external carotid artery are\nvisualized and appear normal\nThe internal carotid artery appears normal with filling of the left MCA and\nbilateral ACAs the anterior communicating artery. The venous phase\ndemonstrates right dominant transverse sinus and appearance of a filling\ndefect in the left transverse sinus.\n\nRight common carotid artery: Branches of the external carotid artery\nvisualized appear normal. Internal carotid artery fills appears normal with\nfilling of the right MCA and bilateral anterior cerebral arteries. \nRedemonstration of right transverse sinus dominance.\n\nLeft vertebral artery: Left vertebral artery is dominant and fills the\nvertebrobasilar system. There is filling of the left posterior inferior\ncerebellar artery. The right anterior inferior cerebellar artery is visualize\nmore than the left. There is filling of the bilateral superior cerebellar\narteries and posterior cerebral arteries.", + "output": "1. No evidence of aneurysm or high flow vascular lesion. No abnormal\narteriovenous shunting.\n2. Nonspecific filling defect in the left transverse sinus which is\nnonocclusive.\n\n___, was personally present and participated in the entirety of the\nprocedure; I have reviewed the above images and agree with the findings as\nstated above.\n\nRECOMMENDATION(S):\n1. Patient to be taken back to the NIMU. Remainder care per primary team." + }, + { + "input": "Limited preprocedure ultrasound of the right axillary region again showed\nmultiple enlarged right axillary lymph nodes. A dominant right axillary lymph\nnode was chosen for ultrasound-guided core biopsy.", + "output": "Technically successful US-guided core biopsy x 5 of a right axillary\nlymphadenopathy (lymphoma protocol). Pathology is pending." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 88 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 58 cm/s, 70 cm/s, and 73 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.83.\nThe external carotid artery has peak systolic velocity of98 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 89 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 72 cm/s, 80 cm/s, and 81 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 0.91\nThe external carotid artery has peak systolic velocity of 119 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Normal ultrasound exam of the carotid arteries without evidence of ICA\nstenosis bilaterally." + }, + { + "input": "Survey view of the transplanted kidney again shows mild hydronephrosis and no\nperinephric collection.", + "output": "Sonographic guidance for biopsy of the rightlower quadrant transplant kidney\nby nephrologist." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAn 18 gauge needle was advanced into the largest fluid pocket in the right\nlower quadrant and 20 cc of serosanguinous fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 20 cc of fluid was removed." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, a 16 gauge core biopsy needle was then advanced into the liver and a\nsingle core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy.\n\nEXAMINATION:\nULTRASOUND-GUIDED NON TARGETED LIVER BIOPSY\n\nINDICATION: abnormal lft's 790.6 // abnormal lfts 790.6" + }, + { + "input": "Tissue density: C- The breast tissues are heterogeneously dense and\ndiffusely nodular which lowers the sensitivity of mammography and could\nconceivably obscure a lesion. There are stable postsurgical changes in the\nslightly inner upper left breast. In the area of concern as indicated by the\npatient, there is a spherically calcifying mass measuring 0.5 cm in maximal\nsize which has decreased in overall size since ___ consistent with a benign\nfinding, most likely a calcifying oil cyst. This area was further evaluated\nwith ultrasound. Several benign-appearing small intramammary lymph nodes are\nalso again identified in the upper outer breast. No suspicious grouped\nmicrocalcifications are seen.\n\nUltrasound of the left breast from ___ o'clock 1-15 cm from the nipple in the\narea of concern as indicated by the patient was performed. At 1 o'clock 6-7\ncm from the nipple is identified a 0.5 x 0.3 x 0.4 cm hypoechoic mass which is\nstable since ___ and is felt to likely correspond to the calcified oil cyst\non mammography. If there is a need for more immediate diagnostic certainty,\nultrasound-guided core biopsy could be performed. No suspicious solid mass is\nseen.\n\nImaging of the left axilla identified several benign-appearing lymph nodes,\nthe largest of which measures 0.8 cm. No pathologic lymphadenopathy is seen. \nFurther management of patient's symptoms at this time should be based on the\nclinical assessment.", + "output": "0.5 cm probable calcifying oil cyst at 1 o'clock in the left breast\ncorresponding to the area of concern as indicated by the patient. Any\ndecision to biopsy at this time should be based on the clinical assessment.\n\nBenign-appearing left axillary nodes. No pathologic lymphadenopathy. Further\nmanagement of the patient's symptoms at this time should be based on the\nclinical assessment.\n\nStable left postsurgical changes. No specific mammographic evidence of\nmalignancy in the left breast.\n\nRECOMMENDATION: Bilateral mammography in ___. Clinical followup.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. An\nemail was sent to ___ NP summarizing the recommendations on ___ at 14:45.\n\nBI-RADS: 2 Benign." + }, + { + "input": "At ___ o'clock in the left breast 6 cm from the nipple again demonstrates an\noval circumscribed avascular hypoechoic mass with posterior acoustic\nenhancement which is stable since ___ and appears to correspond to\nthe partially calcified mass on mammography which has decreased in size since\n___. Findings are consistent with an oil cyst. After re-reviewing the\nimaging with the patient as well as discussing risks and benefits of\nultrasound-guided core biopsy, the patient decided to defer biopsy at this\ntime.", + "output": "Oil cyst at ___ o'clock in the left breast. After re-reviewing the imaging\nanddiscussing risks and benefits of ultrasound-guided core biopsy , the\npatient decided to defer biopsy at this time.\n\nRECOMMENDATION(S): Bilateral mammography in ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. The findings were also communicated to ___\n___, N.P. by ___, M.D. by email on ___ at 11:54 am.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 2.2 cm circumscribed mass seen in the right lateral breast at\nposterior depth consistent with the cyst seen on ultrasound. There is a 1.2\ncm well-circumscribed mass in the right inferior slightly medial breast\nconsistent with a cyst as seen on ultrasound. A stable 7 x 5 mm circumscribed\nmass is noted in the immediate retroareolar region on CC view similar to ___.\nOtherwise, there is no suspicious dominant mass, architectural distortion or\nsuspicious grouped calcification. Scattered benign-appearing calcifications\nare noted.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at 9 o'clock\n7 cm from the nipple demonstrates a 2.4 x 1.0 x 1.9 cm bilobed anechoic\navascular cyst corresponding to the mammographic finding in the lateral\nbreast.\nTargeted ultrasound at 6 o'clock 4 cm from the nipple demonstrates a 1.2 x 0.9\nby 1.2 cm simple anechoic avascular cyst, corresponding to the mammographic\nfinding in the inferior slightly medial breast.", + "output": "No specific evidence of malignancy in the right breast. Simple cysts, the\nlargest is in the lateral breast measuring 2.4 cm by ultrasound.\n\nRECOMMENDATION(S): Patient is due for her annual mammogram in ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the area of palpable concern, a 0.6 x 0.4 x 1.0 cm well-circumscribed\nsubcutaneous nodule with a fatty hilum is identified, representing a lymph\nnode. There is no increased internal vascularity, and no other soft tissue\nmasses or focal abnormalities are identified.", + "output": "Normal-appearing lymph node in the left occipital scalp, at the area of\npalpable concern." + }, + { + "input": "In the left axilla, there are normal appearing lymph nodes without evidence of\nsuspicious solid or cystic mass.", + "output": "Left axillary lymph nodes are benign. No suspicious sonographic abnormality\nin the left axilla. Any decision for further intervention should be guided by\nthe clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up, annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "At 9 o'clock 7-8 cm from the right nipple, there are three contiguous oval\nanechoic masses with posterior enhancement consistent with simple cysts\nmeasuring as follows: 0.3 x 0.3 x 0.3 cm, 1.3 x 1.2 x 0.8 cm, and 0.9 x 0.7 x\n0.5 cm. No solid suspicious mass is seen.", + "output": "Simple cysts at 9 o'clock in the right breast likely corresponding to the mass\nseen on recent screening mammogram dated ___ and likely related to\nthe patient's vaginal cream. Clinical correlation is recommended. Routine\nmammographic screening seems reasonable at this time.\n\nRECOMMENDATION(S): Annual screening mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissues are heterogeneously dense and\ndiffusely nodular which lowers the sensitivity of mammography and could\nconceivably obscure a lesion. There are stable postsurgical changes in the\nslightly inner upper left breast. In the area of concern as indicated by the\npatient, there is a spherically calcifying mass measuring 0.5 cm in maximal\nsize which has decreased in overall size since ___ consistent with a benign\nfinding, most likely a calcifying oil cyst. This area was further evaluated\nwith ultrasound. Several benign-appearing small intramammary lymph nodes are\nalso again identified in the upper outer breast. No suspicious grouped\nmicrocalcifications are seen.\n\nUltrasound of the left breast from ___ o'clock 1-15 cm from the nipple in the\narea of concern as indicated by the patient was performed. At 1 o'clock 6-7\ncm from the nipple is identified a 0.5 x 0.3 x 0.4 cm hypoechoic mass which is\nstable since ___ and is felt to likely correspond to the calcified oil cyst\non mammography. If there is a need for more immediate diagnostic certainty,\nultrasound-guided core biopsy could be performed. No suspicious solid mass is\nseen.\n\nImaging of the left axilla identified several benign-appearing lymph nodes,\nthe largest of which measures 0.8 cm. No pathologic lymphadenopathy is seen. \nFurther management of patient's symptoms at this time should be based on the\nclinical assessment.", + "output": "0.5 cm probable calcifying oil cyst at 1 o'clock in the left breast\ncorresponding to the area of concern as indicated by the patient. Any\ndecision to biopsy at this time should be based on the clinical assessment.\n\nBenign-appearing left axillary nodes. No pathologic lymphadenopathy. Further\nmanagement of the patient's symptoms at this time should be based on the\nclinical assessment.\n\nStable left postsurgical changes. No specific mammographic evidence of\nmalignancy in the left breast.\n\nRECOMMENDATION: Bilateral mammography in ___. Clinical followup.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. An\nemail was sent to ___ NP summarizing the recommendations on ___ at 14:45.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 1 0 seconds\ncm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 104, 70 seconds, and 55. Cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 17\ncm/sec.\nThe ICA/CCA ratio is ___.\nThe external carotid artery has peak systolic velocity of 223 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 160, 70, and 68 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 13\ncm/sec.\nThe ICA/CCA ratio is 1.95.\nThe external carotid artery has peak systolic velocity of 117 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA<40% stenosis.\nLeft ICA 60-69% stenosis." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with approximately 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 2 18-gauge core biopsy passes were made. \nThe sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: No moderate sedation was provided.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to\npathology." + }, + { + "input": "Transverse and sagittal images were obtained of the deep tissues of the right\nsubmandibular region. The right external jugular vein is compressible with\nappropriate waveforms and wall-to-wall color flow. The right internal jugular\nvein and common carotid artery are visualized with normal wall-to-wall flow\nwithout any filling defect.", + "output": "No evidence of DVT in the right external jugular vein." + }, + { + "input": "Right radial artery: Vessel caliber smooth regular. There is filling of the\nrenal artery retrograde flow into the brachial artery with flow into the\nulnar, anterior, and posterior interosseous arteries.\n\nRight vertebral artery: Vessel caliber smooth regular. Filling of the right\nposterior inferior cerebellar artery and filling of bilateral\nanterior-inferior cerebellar arteries, bilateral superior cerebellar arteries\nbilateral posterior cerebral arteries and their distal territories. There is\nretrograde filling of the bilateral posterior cerebral arteries with flash\nfilling of the anterior circulation. No evidence of dural AV fistula, a AVMs,\naneurysms. Normal arterial, capillary, and venous phase. In the cervical\nview of the vertebral artery there is no evidence of intracranial extracranial\nanastomoses the new the radicular arteries no evidence of dural AV fistula.\n\nRight external carotid artery: Vessel caliber smooth regular. There is\nfilling of the external carotid artery and its distal branches. There is no\nevidence of intracranial extracranial anastomoses or dural AV fistulas.\n\nRight internal carotid artery: Vessel caliber smooth regular. There is\nfilling of the anterior middle cerebral arteries as well as their distal\nterritories. There is filling across the anterior communicating artery into\nthe contralateral A2. The ophthalmic artery is patent there is filling across\nposterior communicating artery into the posterior cerebral circulation. No\naneurysms or AVMs are identified. Normal arterial, capillary, venous phase.\n\nLeft external carotid artery: Vessel caliber smooth regular. Is filling of\nthe external carotid artery and its distal branches. There is no evidence of\nintracranial extracranial anastomoses of dural AV fistulas.\n\nLeft internal carotid artery: Vessel caliber smooth regular. There is filling\nof the anterior middle cerebral arteries and their distal territories. The\nophthalmic arteries patent and there is filling of small posterior\ncommunicating artery which does not fill the posterior cerebral circulation. \nNo evidence of aneurysms or AVMs. Normal arterial, capillary, venous phase.\n\nLeft vertebral artery: Vessel caliber smooth regular. Cervical radicular\narteries are identified no evidence of dural arteriovenous fistula. There is\nfilling of the left posterior inferior cerebellar artery. Vessel posterior\ncirculation fill as noted in the right vertebral artery injection. No\nevidence of dural AV fistula from the left vertebral artery. The arterial,\ncapillary, venous phase.", + "output": "Negative cerebral angiogram for intracranial vascular lesion or dural av\nfistula of the spine.\n\nRECOMMENDATION(S):\n1. No neurosurgical followup required." + }, + { + "input": "Preprocedure ultrasound at the site of palpable abnormality indicated by the\npatient demonstrates a 5 x 3 x 5 mm cystic mass, targeted for\nultrasound-guided core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: The procedure was performed by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Achive needle. The mass became less\nvisible with each subsequent pass. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance. The clip is immediately lateral to the\nresidual mass. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: As the patient has no residual right breast tissue,\nno postprocedure mammogram was performed.", + "output": "US-guided core biopsy of a mass in the right mastectomy bed, 7 cm lateral to\nthe tattoo mark. The coil clip is immediately lateral to the residual mass. \nPathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "At the site of palpable area of concern indicated by the patient, there is a 4\nx 3 x 5 mm hypoechoic mass with internal echoes and mild surrounding\nechogenicity. There is no internal vascularity. There is minimal through\ntransmission. This is unchanged from ___ when it measured 5 x 4 x 7\nmm, allowing for differences in technique.", + "output": "Palpable abnormality corresponds to a 5 mm cystic mass, with the appearance of\nfat necrosis. Mammogram was not technically feasible due to lack of right\nbreast tissue after mastectomy.\n\nRECOMMENDATION(S): The options of followup versus biopsy were discussed with\nthe patient. She opted for biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The biopsy was subsequently performed.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the left inguinal region in the subcutaneous tissues approximately 1.5 cm\ndeep to the skin there is a 4.3 x 4.4 x 2.3 cm largely anechoic fluid\ncollection without associated hypervascularity favored to represent\npostoperative seroma or hematoma. The cavity collapsed after aspiration of\napproximately 10 cc of serous fluid.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation. The cavity collapsed\nafter aspiration of 10 cc of serous fluid." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 45 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 158, 112, and 76 cm/sec, respectively. However the\nend-diastolic velocity is 0 suggesting distal occlusion or high-grade\nstenosis.\nThe ICA/CCA ratio is 3.5.\nThe external carotid artery has peak systolic velocity of 50 cm/sec.\nThe vertebral artery is patent with compensatory antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 81, 129, and 121 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 29\ncm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 120 seconds cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICAwith no diastolic flow suggesting distal occlusion.\nLeft ICA 40-59% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque in\nthe ICA.\nThe peak systolic velocity in the right common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 53, 68, and 55 cm/sec, respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.71.\nThe external carotid artery has peak systolic velocity of 155 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque in\nthe ICA.\nThe peak systolic velocity in the left common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 61, 82, and 58 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous atherosclerotic plaque at the origin of both ICAs resulting\nin less than 40% stenosis bilaterally." + }, + { + "input": "Large abdominal/retroperitoneal fluid collection with some septations, likely\nrepresenting hematoma.", + "output": "Successful US-guided aspiration of the collection. Samples was sent for\nmicrobiology evaluation." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nRIGHT BREAST: Extensive vascular calcifications are noted. In the central to\nslightly upper, inner right breast there is a 3 cm oval circumscribed\nhyperdense mass subjacent to the BB marker, which was further evaluated with\ntargeted ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nLEFT BREAST: Extensive vascular calcifications are noted. There is no\nsuspicious mass, unexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of\npalpable concern, as indicated by the patient.\n\nAt 2 o'clock, 6 cm from the nipple there is 2.2 x 1.2 x 2.7 cm oval\ncircumscribed thick-walled hypoechoic fluid collection, with a hyperechoic\nrim, containing echogenic debris which demonstrates peripheral vascularity and\nincreased through transmission. Given the patient's history of current\nanticoagulation with a history of supratherapeutic INR, this likely represents\na hematoma.", + "output": "A palpable right breast mass has an appearance most consistent with a hematoma\nin this patient who is currently anticoagulated, with recent history of\nsupratherapeutic INR. However, given the absence of reported trauma,\nfollow-up breast ultrasound in 1 month is recommended to document resolution.\n\nRECOMMENDATION(S): Follow-up right breast ultrasound in 1 month.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nAdditionally, findings and recommendations were communicated via email to Dr.\n___ by ___, M.D. at 15:25 on ___.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nRIGHT BREAST: Extensive vascular calcifications are noted. In the central to\nslightly upper, inner right breast there is a 3 cm oval circumscribed\nhyperdense mass subjacent to the BB marker, which was further evaluated with\ntargeted ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nLEFT BREAST: Extensive vascular calcifications are noted. There is no\nsuspicious mass, unexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of\npalpable concern, as indicated by the patient.\n\nAt 2 o'clock, 6 cm from the nipple there is 2.2 x 1.2 x 2.7 cm oval\ncircumscribed thick-walled hypoechoic fluid collection, with a hyperechoic\nrim, containing echogenic debris which demonstrates peripheral vascularity and\nincreased through transmission. Given the patient's history of current\nanticoagulation with a history of supratherapeutic INR, this likely represents\na hematoma.", + "output": "A palpable right breast mass has an appearance most consistent with a hematoma\nin this patient who is currently anticoagulated, with recent history of\nsupratherapeutic INR. However, given the absence of reported trauma,\nfollow-up breast ultrasound in 1 month is recommended to document resolution.\n\nRECOMMENDATION(S): Follow-up right breast ultrasound in 1 month.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nAdditionally, findings and recommendations were communicated via email to Dr.\n___ by ___, M.D. at 15:25 on ___.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At 2 o'clock approximately 6 cm from nipple there is re-demonstration of a\nheterogeneous mass containing hypoechoic center surrounded by a hyperechoic\nrim. This is smaller than the prior study now measuring 1.8 x 0.7 x 2 cm. \nThis is most consistent with a resolving hematoma. However continued\nfollow-up is recommended to ensure complete resolution.", + "output": "Decrease in the size of a hematoma since the prior study. Follow-up in 3\nmonths is recommended to ensure complete resolution.\n\nRECOMMENDATION(S): Right breast ultrasound in 3 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Examination of the right groin demonstrates normal flow in the common femoral\nartery and vein, as well as proximal superficial femoral artery, femoral vein\nand greater saphenous vein. There is no evidence of pseudoaneurysm.\n\nThe previously demonstrated hypoechoic collection in the right groin/proximal\nthigh along the tract of the previous dialysis line has significantly\ndecreased in size. The residual collection measures approximately 2.5 x 0.6 x\n3.7 cm, compared with approximately 1.2 x 1.4 x 4.9 cm previously. This is\nmost consistent with resolving hematoma (it is noted that this was previously\nincised and drained and was an abscess as per the previous CT report of ___.\n\nIn the left groin, there is a persistent pseudoaneurysm arising from the\ncommon femoral artery demonstrating typical to and fro flow. The main\ncomponent of this measures 1.3 x 0.6 x 0.7 cm and the neck measures 0.3 cm in\ndiameter and approximately 1.1 cm in length. It is similar in size and\nconfiguration to the CT from ___.\n\nThere is no evidence of hematoma or other collection in the left groin.", + "output": "1. Persistent blood flow in the known left common femoral pseudoaneurysm.\n2. Trace residual right groin/proximal thigh collection at the location of the\nprevious dialysis line.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 16:20 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." + }, + { + "input": "Seen again in the left groin is the pseudoaneurysm from the common femoral\nartery. There is no evidence of flow in the lumen consistent with thrombosis.\nThe pseudoaneurysm remains unchanged in size measuring 1.6 x 0.5 x 1.5 cm.\n\nThere is normal flow in the common femoral artery and vein. There is no\nevidence of hematoma.", + "output": "Pseudoaneurysm in the left groin shows evidence of thrombosis. Remains\ngrossly unchanged in size compared to prior study from ___." + }, + { + "input": "2 o'clock 6 cm from the nipple was evaluated. The previously seen abnormal\narea has resolved, presumably representing hematoma. This corresponds to the\nabsence of an abnormality on the recent mammogram image. No abnormalities\nidentified in this targeted location of the right breast.", + "output": "Resolution of previously seen probable hematoma.\n\nRECOMMENDATION(S): Return to screening in one year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND: The upper inner left breast was scanned and no\nabnormalities were identified.", + "output": "No evidence for malignancy.\n\nRECOMMENDATION(S): Clinical follow-up for left breast area of clinical\nconcern.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nRight: There is a new 5 x 4 x 4 mm mass in the right upper outer quadrant at\nposterior depth, which corresponds to the ultrasound finding.\nOtherwise, the right breast is without suspicious grouped calcifications. A\nfew scattered benign calcifications are noted.\n\nLeft: The left breast demonstrates stable post treatment changes centrally\nwith architectural distortion and surgical clips and volume loss. Clips are\nalso noted in the left axilla. The left breast is without suspicious dominant\nmass, unexplained architectural distortion or suspicious grouped\ncalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right upper outer quadrant\nat 10 o'clock 12 cm from the nipple demonstrates a 6 x 5 x 6 mm irregular\nhyperechoic mass without dominant vascularity or posterior shadowing. The\nmass has a slight hypoechoic center. This corresponds to the location of the\nmass seen on mammography.", + "output": "6 mm highly suspicious right breast mass concerning for carcinoma.\n\nGiven the patient's other issues with diffuse metastatic disease, a biopsy of\nthis lesion is not felt to be necessary, however, could be performed if needed\nto assist with therapeutic management.\n\nRECOMMENDATION(S): Clinical care for her diffuse metastatic disease. \nFollow-up of this 6 mm suspicious mass would depend on therapeutic plans.\n\nNOTIFICATION: Findings were discussed with the patient. At this time she\nagrees that biopsy of this lesion is not indicated unless her clinicians would\nlike it to be biopsied.\n\nPreliminary email with the above findings was sent her clinicians at 14:55.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nRight: There is a new 5 x 4 x 4 mm mass in the right upper outer quadrant at\nposterior depth, which corresponds to the ultrasound finding.\nOtherwise, the right breast is without suspicious grouped calcifications. A\nfew scattered benign calcifications are noted.\n\nLeft: The left breast demonstrates stable post treatment changes centrally\nwith architectural distortion and surgical clips and volume loss. Clips are\nalso noted in the left axilla. The left breast is without suspicious dominant\nmass, unexplained architectural distortion or suspicious grouped\ncalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right upper outer quadrant\nat 10 o'clock 12 cm from the nipple demonstrates a 6 x 5 x 6 mm irregular\nhyperechoic mass without dominant vascularity or posterior shadowing. The\nmass has a slight hypoechoic center. This corresponds to the location of the\nmass seen on mammography.", + "output": "6 mm highly suspicious right breast mass concerning for carcinoma.\n\nGiven the patient's other issues with diffuse metastatic disease, a biopsy of\nthis lesion is not felt to be necessary, however, could be performed if needed\nto assist with therapeutic management.\n\nRECOMMENDATION(S): Clinical care for her diffuse metastatic disease. \nFollow-up of this 6 mm suspicious mass would depend on therapeutic plans.\n\nNOTIFICATION: Findings were discussed with the patient. At this time she\nagrees that biopsy of this lesion is not indicated unless her clinicians would\nlike it to be biopsied.\n\nPreliminary email with the above findings was sent her clinicians at 14:55.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. The previously identified 5 mm mass in the right upper\nouter quadrant at posterior depth is not appreciated on this examination.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses in the area of the previously seen\nright breast mass.", + "output": "The previously identified 5 mm mass in the upper outer right breast is not\nappreciated sonographically or mammographically on today's examination.\n\nRECOMMENDATION(S): Clinical care for her diffuse metastatic disease.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "There is moderate to severe right common femoral artery plaque.\n\nPeak systolic velocities are as follows:\nCommon femoral artery waveform is triphasic.\n\nPeak systolic velocity of the native CFA is 53 cm/sec just before the\nanastomosis.\nPeak systolic velocity at the proximal CFA-graft anastomosis is 53 cm/s.\nPeak systolic velocity of the graft at the proximal thigh is 64\ncentimeters/second.\nPeak systolic velocity of the graft at the midthigh is 89 centimeters/second.\nPeak systolic velocity of the graft at the distal thighs 70\ncentimeters/second. Peak systolic velocity at the mid knee is 125\ncentimeters/second.\nPeak systolic velocity at the proximal calf is 184 centimeters/second. Peak\nsystolic velocity at the mid calf is 199 centimeters/second.\nPeak systolic velocity at the distal calf is 255 centimeters/second.\nPeak systolic velocity at the distal graft-posterior tibial artery anastomosis\nis 139 centimeters/second.\nPeak systolic velocity within the native posterior tibial artery is 119\ncentimeters/second.", + "output": "Patent right femoral-PTA graft with peak systolic velocities as described\nabove." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 88, 97, and 99 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 32\ncm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 102, 102, and 80 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 37\ncm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "The patient is status post right superficial artery to posterior tibial artery\nbypass grafting.\n\nPeak systolic velocities are as follows from proximal to distal:\nSuperficial femoral artery: 36 cm/sec\nProximal anastomosis: 133 cm/sec\nIntragraft velocities (proximal to distal): 134, 52, 43, 30, 366, 477, 35, 26\nDistal anastomosis: 36 cm/sec\nPosterior tibial artery: 27 cm/sec", + "output": "Patent right SFA to posterior tibial artery graft with severe stenosis within\nthe proximal right calf." + }, + { + "input": "Ultrasound of the right breast from 8 o'clock to 11 o'clock, 15 cm from the\nnipple at site of pain indicated by the patient was performed. No cystic or\nsolid mass is identified. Incidentally noted at 9 o'clock, 15 cm from the\nnipple is a 4 x 3 x 6 mm oval circumscribed hypoechoic solid mass with no\ninternal vascularity, likely representing a small fibroadenoma.\n\nUltrasound of the right breast at 9 o'clock, 5-10 cm from the nipple at site\nof previously palpable abnormality indicated by the patient demonstrates no\nsuspicious solid or cystic mass.\n\nUltrasound of the right breast at 8 o'clock, 1-10 cm from the nipple at site\nof prominent tissue indicated by the referring physician also demonstrates no\nsuspicious solid or cystic mass.", + "output": "Incidentally noted 6 mm solid mass at 9 o'clock, 15 cm from the nipple likely\nrepresents a small fibroadenoma. Six-month follow-up ultrasound is\nrecommended. This is unlikely to be the cause of patient's breast pain. No\nsonographic abnormality at site of previously palpable abnormality or at site\nof prominent tissue in the right breast.\n\nRECOMMENDATION(S): Right breast ultrasound in 6 months for the followup of\nprobably benign mass. Clinical followup for the area of palpable concern in\nthe pain. Per the patient, she may have her records released and opt to have\nher follow-up at ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up. \nShe was also given a medical release form in case she chooses not to have her\nfollow up at ___.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Focused ultrasound in the abdominal wall at the site of palpable abnormality\nperformed. There is poorly defined hypoechoic nonvascular collection measuring\napproximately 4 cm in maximal transverse dimension likely representing a small\nhematoma, less likely phlegmon. No drainable fluid collection is seen.\nPartially imaged is abdominal ascites.", + "output": "Small hematoma versus phlegmon at the site of palpable abnormality in the\nabdominal wall. Abdominal ascites partially imaged." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen\n\nLeft common carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral artery and their distal\nterritories. There is filling of the bilateral a 2 segments. There is no\nevidence of aneurysm or AVM. The venous phase is unremarkable.\n\nRight internal carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral arteries their distal territories. \nThere is an irregular bilobed aneurysm arising from the MCA bifurcation. It\nmeasures 5 x 5 mm. The superior and inferior divisions appear to come off at\nnearly 180 degree angles. There is no evidence of additional aneurysm or AVM.\nThree-dimensional images confirm this.\n\nRight internal carotid artery following stent: There is no evidence of InStent\nstenosis or thrombosis or vessel dropout. It is difficult to discern the\nstent on the contrasted opacified image. It is more discernible on the single\nshot x-ray. The stent travels from the superior division of the MCA into the\nM1.\n\nRight internal carotid artery after coiling: There is partial occlusion of the\naneurysm. There is still filling of the posterior portion that is close to\nthe takeoff of the branch arteries. This is further delineated on\nthree-dimensional imaging.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "___ 3, satisfactory stent coiling of unruptured right MCA aneurysm. \nWill follow-up with plans for additional thrombosis over time versus need for\nadditional treatment.\n\nRECOMMENDATION(S):\n1. See above" + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 5 cm group of pleomorphic calcifications in the upper inner right\nbreast, extending to the nipple.\nThere is an approximately 7 mm group of round calcifications in the posterior\nouter central right breast, which have not significantly changed dating back\nto ___ and are probably benign. There are no suspicious masses or\ndistortions in the right breast. Further evaluation was performed with\ntargeted ultrasound.\n\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper inner right breast was\nperformed. Abnormal tubular hypoechoic tissue measuring 15 x 8 mm, containing\nbright echogenic reflectors, likely representing calcifications is seen at\n1:00 position 2 cm from the nipple, likely representing dilated duct with\ncalcifications, corresponding to those seen on mammography. Ultrasound of the\nright axilla reveals normal-appearing lymph nodes.", + "output": "There are suspicious calcifications extending for 5 cm which could be seen on\nmammogram and ultrasound in the upper inner right breast. Tissue diagnosis of\nthese calcifications is recommended.\n\nGrouped round calcifications in the outer posterior right breast are probably\nbenign.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast\nseems reasonable at this time as the patient would like to have tissue\ndiagnosis as soon as possible and the suspicious calcifications seem to be\nvisible on ultrasound.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. Ultrasound-guided core needle biopsy will be\nperformed later this afternoon. The impression and recommendation above was\nentered by Dr. ___ on ___ at 09:25 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 5 cm group of pleomorphic calcifications in the upper inner right\nbreast, extending to the nipple.\nThere is an approximately 7 mm group of round calcifications in the posterior\nouter central right breast, which have not significantly changed dating back\nto ___ and are probably benign. There are no suspicious masses or\ndistortions in the right breast. Further evaluation was performed with\ntargeted ultrasound.\n\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper inner right breast was\nperformed. Abnormal tubular hypoechoic tissue measuring 15 x 8 mm, containing\nbright echogenic reflectors, likely representing calcifications is seen at\n1:00 position 2 cm from the nipple, likely representing dilated duct with\ncalcifications, corresponding to those seen on mammography. Ultrasound of the\nright axilla reveals normal-appearing lymph nodes.", + "output": "There are suspicious calcifications extending for 5 cm which could be seen on\nmammogram and ultrasound in the upper inner right breast. Tissue diagnosis of\nthese calcifications is recommended.\n\nGrouped round calcifications in the outer posterior right breast are probably\nbenign.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast\nseems reasonable at this time as the patient would like to have tissue\ndiagnosis as soon as possible and the suspicious calcifications seem to be\nvisible on ultrasound.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. Ultrasound-guided core needle biopsy will be\nperformed later this afternoon. The impression and recommendation above was\nentered by Dr. ___ on ___ at 09:25 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "At 1:00 position 3 cm from the nipple in the right breast again seen is a\nhypoechoic duct with calcifications, which was targeted for the biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___, M.D.. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle and 14-gauge Bard spring-loaded biopsy\ndevicewere used to obtain 6 cores. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "At 1:00 position 3 cm from the nipple in the right breast again seen is a\nhypoechoic duct with calcifications, which was targeted for the biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___, M.D.. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle and 14-gauge Bard spring-loaded biopsy\ndevicewere used to obtain 6 cores. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left\nupperquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nupper quadrant and 2 L of purulent yellow fluid was removed. A ___ wire\nwas advanced through the 5 ___ catheter and following a skin ___, a 8\n___ biliary drain was advanced. The wire was removed, the pigtail was\nlocked and the catheter was secured using 3 0 silk sutures and a Stat Lock\ndevice. The catheter was attached to a JP bulb.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Successful placement of a 8 ___ left paracentesis drain attached to a JP\nbulb." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 129, 166, and 145 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 2.0.\nThe external carotid artery has peak systolic velocity of 428 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 92 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 135, 98, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 164 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate right extracranial internal carotid artery atherosclerosis with\n60- 69% stenosis\n2. Moderate left extracranial internal carotid artery atherosclerosis with\n40-59% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild intimal thickening.\nThe peak systolic velocity in the right common carotid artery is 108 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 59, 61, and 63 cm/sec, respectively, with mild spectral\nbroadening. The peak end diastolic velocity in the right internal carotid\nartery is 30 cm/sec.\nThe ICA/CCA ratio is 0.59.\nThe external carotid artery has peak systolic velocity of 64 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild intimal thickening.\nThe peak systolic velocity in the left common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 51, 55, and 58 cm/sec, respectively, with mild spectral\nbroadening. The peak end diastolic velocity in the left internal carotid\nartery is 28 cm/sec.\nThe ICA/CCA ratio is 0.67.\nThe external carotid artery has peak systolic velocity of 69 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nIncidentally noted prominent bilateral level IIa lymph nodes, measuring up to\n2.6 cm in greatest dimension on the right, and 3.3 cm in greatest dimension on\nthe left.", + "output": "1. Mild intimal thickening of the bilateral internal carotid arteries with\nmild spectral broadening of the arterial waveforms, representing mild (___)\nstenosis.\n2. Incidentally noted prominent bilateral level IIa lymph nodes." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: The breast tissue is almost entirely fatty.\nA BB projects over the area of clinical concern in the lower inner left\nbreast. There is an associated density that likely contains hyperlucency\nsuggesting associated fat. Additional left breast nodularity is are all stable\nsince ___. No suspicious microcalcifications or unexplained architectural\ndistortion is identified.\n\nLEFT BREAST ULTRASOUND:\n\nThe left breast was scanned in the area of clinical concern. At 7 o'clock 7\ncm from the nipple there is a 0.3 x 0.2 x 0.3 cm hypoechoic nodule with\nsurrounding echogenic halo. There is no internal vascularity. This likely\nrepresents an area of fat necrosis given its appearance on mammography.", + "output": "The area of clinical concern in the left breast likely represents an area fat\nnecrosis due to the patient's bilateral reduction mammoplasty.\n\nRECOMMENDATION: Six-month followup left breast ultrasound is recommended to\ndocument stability or resolution.\n\nNOTIFICATION: This was discussed with the patient at the time of the exam.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: The breast tissue is almost entirely fatty.\nA BB projects over the area of clinical concern in the lower inner left\nbreast. There is an associated density that likely contains hyperlucency\nsuggesting associated fat. Additional left breast nodularity is are all stable\nsince ___. No suspicious microcalcifications or unexplained architectural\ndistortion is identified.\n\nLEFT BREAST ULTRASOUND:\n\nThe left breast was scanned in the area of clinical concern. At 7 o'clock 7\ncm from the nipple there is a 0.3 x 0.2 x 0.3 cm hypoechoic nodule with\nsurrounding echogenic halo. There is no internal vascularity. This likely\nrepresents an area of fat necrosis given its appearance on mammography.", + "output": "The area of clinical concern in the left breast likely represents an area fat\nnecrosis due to the patient's bilateral reduction mammoplasty.\n\nRECOMMENDATION: Six-month followup left breast ultrasound is recommended to\ndocument stability or resolution.\n\nNOTIFICATION: This was discussed with the patient at the time of the exam.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nA BB projects over the upper outer right breast. Beneath this, in the\nsuperficial breast, there is a vague hyperdensity measuring up to\napproximately 0.7 cm. This was further evaluated with ultrasound. No\nadditional abnormalities are identified in either breast. The previously\nnoted density in the lower inner left breast is no longer identified and has\nresolved.\n\nRIGHT BREAST ULTRASOUND: At 9 o'clock 6 cm from the nipple there is a 0.9 x\n0.4 x 1.0 cm predominantly hyperechoic area with a 0.2 cm anechoic focus. \nThere is minimal internal vascularity. This has the appearance of fat\nnecrosis and correlates nicely with the mammographic finding on the palpable\narea of clinical concern. Six-month follow-up right breast ultrasound is\nrecommended to confirm resolution.\n\nLEFT BREAST ULTRASOUND: The lower inner left breast was scanned to followup\nthe previously noted ultrasound finding and no abnormalities are identified.", + "output": "1. Right breast lump correlates with a probable area fat necrosis. Six-month\nfollow-up right breast ultrasound is recommended.\n\n2. Previously noted mass in the left breast has resolved.\n\nRECOMMENDATION(S): Six-month follow-up right breast ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "A lobulated lymph node with thickened cortex was identified in the right\ninguinal region measuring 1.3 x 1.3 x 0.7 cm. This lymph node was targeted\nfor fine needle aspiration.", + "output": "Technically successful fine-needle aspiration of right inguinal lymph node." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin bilateral internal carotid arteries.\nThe peak systolic velocity in the right common carotid artery is 90 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 67, 72, and 59 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 193 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin bilateral internal carotid arteries.\nThe peak systolic velocity in the left common carotid artery is 91 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 66, 65, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 0.73.\nThe external carotid artery has peak systolic velocity of 172 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild bilateral ICA heterogeneous calcifications. However, no hemodynamically\nsignificant stenosis of bilateral carotid vasculature (less than 40%\nstenosis)." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 2.0 L of serosanguinous fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.0 L of fluid were removed and sent for requested analysis." + }, + { + "input": "The spleen demonstrates normal echogenicity and measures 12.5 cm.\n\nThe previously visualized splenic mass on MR from ___ and CT\nabdomen/pelvis from ___ is redemonstrated on the current study, now\nmeasuring 5.5 x 6.3 x 6.4 cm and demonstrating the same echotexture as the\nspleen. This finding most likely represents a splenic hamartoma.", + "output": "As visualized on prior imaging, there is a splenic mass measuring up to 6.4 cm\nthat demonstrates the same echotexture as the spleen. This finding most\nlikely represents a splenic hamartoma. Otherwise, normal ultrasound of the\nspleen." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 60, 56, and 63 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.72.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has minimal atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 88, 65, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.\nThe external carotid artery has peak systolic velocity of 124 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of significant stenosis in the internal carotid arteries\nbilaterally." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no suspicious mass, grouped microcalcification or architectural\ndistortion. .\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of clinical\nconcern which was without any discrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy. No sonographic abnormality\nin the left breast area of clinical concern. Any decision for further\nintervention should be guided by the clinical assessment.\n\nAn addendum will be created upon review of outside prior imaging.\n\nRECOMMENDATION(S): Clinical follow-up, annual screening mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogenous. atherosclerotic plaque.\nThe right common carotid artery has peak systolic/diastolic velocities of\n87/27 cm/sec.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n83/21 cm/sec in its proximal portion, 90/28 cm/sec in its mid portion, and\n95/29 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 107 cm/sec.\nThe vertebral artery has peak systolic velocity of 63 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.0, predictive of less than 40% stenosis.\n\nLEFT:\nThe left carotid vasculature again has mild heterogenous plaque .\nThe left common carotid artery has peak systolic/diastolic velocities of 81/19\ncm/sec.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n83/21 cm/sec in its proximal portion, 98/28 cm/sec in its mid portion, and\n98/26 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 141 cm/sec.\nThe vertebral artery has peak systolic velocity of there 53 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.2 predictive of less than 40% stenosis..", + "output": "Mild heterogenous plaque involving both right and left internal carotid,\nexternal carotid and common carotid arteries.\nFlow velocities of predictive of less than 40% stenosis bilaterally." + }, + { + "input": "SPLEEN: The spleen demonstrates normal echogenicity and normal size, measuring\n7.5 cm.\n\nLimited view of the left kidney demonstrates no hydronephrosis.", + "output": "Normal appearing spleen." + }, + { + "input": "Preprocedure scan demonstrated the presence of a rounded, isoechoic lesion at\nthe upper pole of the left kidney measuring 2.1 x 2.2 cm, corresponding the\nMRI abnormality.", + "output": "Uncomplicated, but technically difficult core biopsy of a left upper pole\nrenal mass." + }, + { + "input": "The liver is of increased echogenicity. It is also coarse in\nechotexture. No focal liver lesions identified. The portal vein is patent\nwith normal centripetal flow. The gallbladder is normal with no evidence of\nany cholelithiasis. The CBD is not dilated at 5 mm. In the midline, the head\nand body of pancreas are visualized, but the tail is somewhat obscured. The\naorta is of normal caliber. The right kidney measures 11.6 cm in maximum\nlength with normal renal cortical thickness. The left kidney measures 11.9 cm\nin maximum length with normal renal cortical thickness. Spleen measures 9 cm.\nThere is no evidence of any ascites.", + "output": "1. Coarsened echotexture and increased echogenicity in liver with no focal\nliver lesions.\n2. Tail of pancreas not well imaged." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque. Moderate\nintimal thickening involving the common carotid artery is noted.\nThe peak systolic velocity in the right common carotid artery is 107 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 103, 76, and 110 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 314 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque. Mild\nintimal thickening involving the common carotid artery is noted.\nThe peak systolic velocity in the left common carotid artery is 140 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 130, 78, and 92 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 0.92.\nThe external carotid artery has peak systolic velocity of 266 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate bilateral atherosclerotic plaque. Intimal thickening involving\nthe bilateral common carotid arteries, right greater than left.\n2. Mild (40-59%) stenosis involving the left internal carotid artery. No\nhemodynamically significant stenosis involving the right carotid system.\n3. Bilateral antegrade vertebral flow." + }, + { + "input": "Focused assessment of the region of clinical tenderness over the right\nproximal posterior thigh, distal and separate to the region of recently\ndescribed ulceration within the right buttock.\n\nLikely within the proximal semimembranosus muscle belly, there is fibrillar\ndisruption, with expansion by a ill-defined 3.9 x 1.0 x 0.9 cm hypoechoic,\nill-defined heterogenous pocket of fluid with a few reticulations likely\nrepresenting blood products, with outward convexity of the superficial\nmuscular fascia, and blunted appearance of the retracted muscle fibers. There\nis no peripheral rind of vascularity, typical for superimposed infection, or\noverlying dermal tract, but this requires correlation. Mild overlying\nsubcutaneous edema. Findings likely reflect a low to intermediate-grade\nhamstring tear with distal retraction of the tendon fibers by at least 3.9 cm,\nand intramuscular hematoma.\n\nOn review of recent CT, we suspect there is pre-existing subcutaneous edema\nwith expansion of the semimembranosus, with background fatty replacement, on\nimage 66, series 2.", + "output": "Constellation of findings likely reflect low to intermediate grade hamstring\ninjury, likely involving the semimembranosus, with 3.9 x 1.0 x 0.9 cm\nintramuscular hematoma." + }, + { + "input": "Limited preprocedure ultrasound of the right posterior thigh again shows a\nseptated collection, which was targeted for ultrasound-guided aspiration.", + "output": "Successful US-guided aspiration of a right posterior thigh hematoma with a\nsample submitted for microbiology evaluation." + }, + { + "input": "The aorta measures 2.6 cm in the proximal portion, 2.2 cm in mid portion and\n1.4 cm in the distal abdominal aorta. There are mild calcified\natherosclerotic plaques.\n\nWall-to-wall color flow is seen within aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.8 cm and the left common iliac artery\nmeasures 0.7 cm.\n\nThe right kidney measures 10.5 cm and the left kidney measures 13.3 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis. A 4.1 x\n4.2 x 4.8-cm simple cyst in the left upper renal pole is overall unchanged in\nsize from ___ when accounting for differences in measurement technique and\nimaging modality. Similarly, a 4.4 x 4.1 x 4.8 cm simple cyst in the left\nlower renal pole is also overall unchanged in size.\n\nIncidentally noted is a hyperechoic liver.", + "output": "No abdominal aortic aneurysm.\n\nEchogenic liver is likely from steatosis. Other forms of liver disease\nincluding steatohepatitis, fibrosis, or cirrhosis cannot be excluded on this\nstudy." + }, + { + "input": "DIGITAL DIAGNOSTIC LEFT MAMMOGRAM WITH CAD:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. No abnormality is noted beneath the triangle pain marker\nin the lower central left breast.\n\nLEFT BREAST ULTRASOUND: In the area of clinical concern at 6 o'clock 1 cm\nfrom the nipple there is a 1.3 x 0.3 x 1.1 cm hypoechoic area within the\ndermal layer that is associated with increased vascularity. The overall skin\nthickness is increased to 0.4 cm. No clear tract is seen extending to the\nskin surface. No underlying breast abnormality is identified. This likely\nrepresents a focal infectious/inflammatory process such as that would be\nrelated to an infected epidermal/sebaceous cyst.\n\nAt the time of the ultrasound examination, a linear area of erythema is noted\nextending from the nipple along the inner central left breast at the 9 o'clock\nlocation. This area was also evaluated and no underlying abnormality is\nnoted.", + "output": "1.3 cm hyperemic area located within the dermal layer in the left breast in\nthe area of clinical concern, probably related to a local infectious/\ninflammatory process such as an infected epidermal/sebaceous cyst.\n\nRECOMMENDATION: Clinical followup is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "A 2.1 x 1.0 x 2.2 cm heterogeneously solid hypoechoic, well-circumscribed mass\nin is seen in the left breast at 8 o'clock, 4 cm from the nipple. The mass\ndemonstrates a parallel orientation and minimal internal flow. No other\nabnormality is identified.", + "output": "2 cm heterogeneously hypoechoic mass in the left breast.\n\nRECOMMENDATION: After discussing with the patient the management plan\noptions, the patient decided that a biopsy for final histologic results is the\nmost desirable choice for her. Guidance was provided about scheduling a\nbiopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Again demonstrated is a 2.1 x 1.0 x 2.1 cm heterogeneously solid hypoechoic\nwell-circumscribed mass in the left breast 8 o'clock position 4 cm from the\nnipple. This mass demonstrates parallel orientation to the chest wall and\nminimal internal flow.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___, Fellow. The procedure was supervised by Dr.\n___, Attending.\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 2 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nNo post-procedure mammogram was performed as the patient is younger than ___\nyears old.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight breast: BB marks area of reported clinical concern. The BB appears\nhigher than the expected location on the MLO view. There is a subtle nodular\nasymmetry seen in the inferior right breast. This area was further assessed\nwith ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nLeft breast: There are mild postsurgical changes in the left breast from prior\nexcisional biopsy. There is no suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right inferior breast was\nperformed with attention to the area palpable abnormality, at 6 o'clock, 5 cm\nfrom the nipple. Corresponding to the lump is a solid hypoechoic oval mass\nmeasuring 16 x 16 x 10 mm. There is no internal vascularity or posterior\nshadowing. Appearances are most suggestive of a fibroadenoma.", + "output": "Probably benign right breast mass at 6 o'clock, corresponding to the palpable\nlump, better seen on ultrasound and mammography due to breast tissue density. \nAppearances are most suggestive of a fibroadenoma.\n\nRECOMMENDATION(S): Options of clinical and six-month ultrasound follow-up, as\nwell as ultrasound-guided core biopsy which would provide tissue diagnosis,\nwere discussed with the patient. She currently favors biopsy for tissue\ndiagnosis.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. An appointment slip and information to schedule the biopsy were given\nto the patient prior to leaving the department.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight breast: BB marks area of reported clinical concern. The BB appears\nhigher than the expected location on the MLO view. There is a subtle nodular\nasymmetry seen in the inferior right breast. This area was further assessed\nwith ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nLeft breast: There are mild postsurgical changes in the left breast from prior\nexcisional biopsy. There is no suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right inferior breast was\nperformed with attention to the area palpable abnormality, at 6 o'clock, 5 cm\nfrom the nipple. Corresponding to the lump is a solid hypoechoic oval mass\nmeasuring 16 x 16 x 10 mm. There is no internal vascularity or posterior\nshadowing. Appearances are most suggestive of a fibroadenoma.", + "output": "Probably benign right breast mass at 6 o'clock, corresponding to the palpable\nlump, better seen on ultrasound and mammography due to breast tissue density. \nAppearances are most suggestive of a fibroadenoma.\n\nRECOMMENDATION(S): Options of clinical and six-month ultrasound follow-up, as\nwell as ultrasound-guided core biopsy which would provide tissue diagnosis,\nwere discussed with the patient. She currently favors biopsy for tissue\ndiagnosis.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. An appointment slip and information to schedule the biopsy were given\nto the patient prior to leaving the department.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Again seen in the right breast at 6 o'clock 5 cm from the nipple is a 1.6 cm\noval hypoechoic mass similar to previous ___.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P. clinician. The procedure was supervised by ___.\n___, M.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:This was deferred due to good visualization of the\nclip under ultrasound, and the fact that the lesion was not seen on\nmammography.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "The 7 x 8 mm hypoechoic and slightly vascular nodule was identified at the\ndistal caudal margin of the pancreatic tail. The localization was confirmed as\na landmark for surgical resection. After mobilization of the pancreatic tail,\nrepeat imaging again demonstrates the small solid hypoechoic nodule. The\ninitial resection specimen did not include the nodule which was seen just\nproximal to the resection margin. Further pancreatic resection was then\nperformed and confirm the nodule within the surgical specimen.", + "output": "8 mm solid pancreatic tail lesion successfully resected with ultrasound\nguidance." + }, + { + "input": "Right breast: The right lower central breast was scanned in the area of\nclinical concern. In the right breast at 6 o'clock 4 cm from the nipple,\nthere is a 0.4 x 0.3 x 0.4 cm circumscribed hypoechoic mass with no internal\nvascularity. This has the appearance of a complicated cyst versus\nfibroadenoma. This likely was incidental and does not relate to the palpable\nabnormality. No additional suspicious findings were seen.\n\nLeft breast: The entire left breast was scanned and no abnormality was\nidentified.", + "output": "Incidental probably benign right breast mass for which 6 month followup right\nbreast ultrasound is recommended. Further management for the other areas of\nclinical concern in both breasts should be based on the clinical assessment.\n\nNOTIFICATION: This was discussed with the patient at the time of the exam.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the 6 o'clock, 4 cm from the nipple there is a circumscribed oval\nhypoechoic mass which measures 0.3 x 0.2 x 0.3 cm and demonstrates no internal\nvascularity or posterior features. This is sonographically stable in\nappearance since previous examination.", + "output": "Six-month stability of benign-appearing right breast mass.\n\nRECOMMENDATION(S): A further 6 month followup with a right breast ultrasound\nis recommended. At that time patient will be due bilateral annual\nmammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is no dominant mass, architectural distortion or suspicious grouped\ncalcifications. Both breasts demonstrate scattered benign punctate\ncalcifications similar to the priors.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 6 o'clock 4 cm\nfrom the nipple demonstrates a small 3 x 2 x 2 mm oval almost anechoic mass\nwithout dominant vascularity or significant posterior features consistent with\na cyst with debris. As this is smaller compared to the priors, no further\nfollowup is needed.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is no dominant mass, architectural distortion or suspicious grouped\ncalcifications. Both breasts demonstrate scattered benign punctate\ncalcifications similar to the priors.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 6 o'clock 4 cm\nfrom the nipple demonstrates a small 3 x 2 x 2 mm oval almost anechoic mass\nwithout dominant vascularity or significant posterior features consistent with\na cyst with debris. As this is smaller compared to the priors, no further\nfollowup is needed.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "SPLEEN: Normal echogenicity, measuring 12.5 cm.\nA round isoechoic mass is identified at the lower pole of the spleen measuring\n11 x 8 cm, larger compared to ___ where it can only be seen in retrospect as\nit is isodense to the spleen (previously 5 x 5 cm).", + "output": "Round 11 cm splenic mass is larger compared to ___. Findings are most\nconsistent with sclerosing angiomatoid nodular transformation (___) of the\nspleen. Hemangioma and hamartoma are considered unlikely. If further\ncharacterization is clinically desired, consider MRI.\n\nRECOMMENDATION(S): If further characterization is clinically desired,\nconsider MRI.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:33 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear yellow fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, cytology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of green tinged fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of loculated ascites with multiple small septations. A suitable target\nin the deepest pocket in the right upper quadrant was selected for\nparacentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Right mid abdomen\nFluid: 650 cc of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 10-cm 5 ___ catheter advanced into the\nlargest fluid pocket. Due to extensive loculations, only approximately 200 cc\nof ascites could be aspirated from the initial location. Under real-time\nsonography, the catheter and needle were repositioned to multiple locations in\nan attempt to allow aspiration from multiple loculations. Eventually the\ntotal of 650 cc were able to be aspirated with only a small amount of residual\nfluid in the RLQ within dense smaller loculations.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 650 cc of clear, straw-colored fluid were removed from the area of\nsignificantly loculated ascites in the right mid abdomen." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nloculated ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 350 cc of green-yellow fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 350 cc of fluid were removed and sent for analysis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque at the bulb\nand proximal ICA.\nThe peak systolic velocity in the right common carotid artery is 120 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 93, 107, and 93 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque at the bulb,\nproximal ICA, and ECA.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 82, 87, and 78 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 46 cm/sec.\nThe vertebral artery is patent with antegrade flow. Note is made that there\nis diminished flow with absence of diastolic flow in the left vertebral\nartery. This is likely technical and due to a hypoplastic vertebral artery\nhowever if clinical concern is present an MRA of the neck could be obtained.", + "output": "1. Less than 40% stenosis of the bilateral carotid arteries with no\nhemodynamically significant stenosis.\n2. Diminished appearance without diastolic flow seen in the left vertebral\nartery. This is likely technical or due to a hypoplastic left vertebral\nartery if clinical concern an MRA of the neck could be obtained." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. There are no new suspicious findings in either breast. A\nradiopaque BB was placed in the area of palpable concern in the lower outer\nright breast. Specifically, there are no new suspicious mammographic\nabnormalities in the vicinity of the BB.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of the\nreported palpable concern in the lower outer right breast. In the 8 o'clock\nposition 4 cm from the nipple there is a 4 x 3 x 5 mm circumscribed hypoechoic\noval mass with no internal vascular flow, likely representing a minimally\ncomplicated cyst. Otherwise, there are no other suspicious cystic or solid\nlesions in the area of the reported palpable concern. Directed physical\nexamination of the lower outer right breast revealed no definite palpable\nabnormalities at this time.", + "output": "1. There are no specific mammographic or sonographic findings corresponding\nto the reported palpable concern. Clinical followup is recommended. Final\npatient disposition and any decision to biopsy should be based on clinical\nassessment.\n\n2. There is an incidental likely benign 5 mm lesion in the lower outer right\nbreast, likely representing a minimally complicated cyst. Short-term interval\nfollowup with a targeted ultrasound of the right breast is recommended to\ndocument stability.\n\nRECOMMENDATION: Clinical follow-up is recommended for the area of clinical\nconcern. Short-term interval followup in 6 months is recommended for the\nincidental probably benign finding in the lower outer right breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\n There is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe lower outer quadrant was scanned. In the 8 o'clock, 6 cm from the nipple\nthere is a heterogeneous hypoechoic oval circumscribed mass which measures 0.4\nx 0.2 x 0.4 cm and demonstrates no internal vascularity or posterior features.\nOn real-time scanning, this has multiple anechoic spaces within it suggesting\nthat this represents either a cluster of cysts or an area of apocrine\nmetaplasia.", + "output": "Six-month stability of probable benign right breast mass.\n\nRECOMMENDATION: Continued followup in 6 months with a right breast ultrasound\nis recommended. At that time patient will be due bilateral annual\nmammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\n There is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe lower outer quadrant was scanned. In the 8 o'clock, 6 cm from the nipple\nthere is a heterogeneous hypoechoic oval circumscribed mass which measures 0.4\nx 0.2 x 0.4 cm and demonstrates no internal vascularity or posterior features.\nOn real-time scanning, this has multiple anechoic spaces within it suggesting\nthat this represents either a cluster of cysts or an area of apocrine\nmetaplasia.", + "output": "Six-month stability of probable benign right breast mass.\n\nRECOMMENDATION: Continued followup in 6 months with a right breast ultrasound\nis recommended. At that time patient will be due bilateral annual\nmammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of\npreviously documented lesion on ultrasound. At 8 o'clock 6 cm from the\nnipple, there is a hypo to isoechoic mass measuring 0.5 x 0.4 x 0.3 cm in\nparallel orientation with few internal nearly anechoic foci suggestive of\napocrine metaplasia.", + "output": "1. ___ year stability of probably benign mass in the right breast at 8 o'clock.\n2. No specific evidence of malignancy in the left breast.\n\nRECOMMENDATION(S): Continued followup of the right breast with ultrasound in\n___ year is recommended to evaluate ___ year stability. The patient will be due\nfor annual bilateral screening at that time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. There is no significant change.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. At the 8 o'clock\nposition of the right breast 6 cm from the nipple, there is a 4 x 4 x 3 mm\noval hypoechoic mass which is not significantly changed in comparison to prior\nstudies dating to ___. At the 8 o'clock position of the right\nbreast 4 cm from the nipple, there is a 4 x 4 x 2 mm oval hypoechoic mass\nwhich is not significantly changed in comparison to prior studies of ___. there is no new suspicious solid or cystic mass.", + "output": "No specific mammographic evidence of malignancy. Stable right breast masses\nare probably benign, not significantly changed since ___.\n\nRECOMMENDATION(S): Continued follow-up right breast ultrasound recommended in\n___ year at the time of annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is an oval, focal asymmetry in the lower inner right breast at anterior\nto mid depth measuring 0.8-0.9 cm that persists on the MLO spot compression\nview.\n\nThere is a circumscribed macrolobulated asymmetry in the lateral right breast\nmeasures 0.5 cm at mid depth and a larger macrolobulated mass in the lateral\nanterior right breast measuring 1 cm. These will be further evaluated by\nultrasound.\n\nThere are no suspicious grouped calcifications or unexplained architectural\ndistortion in the right breast.\n\nThere is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications in the left breast.\n\nBREAST ULTRASOUND:\n\nAt 8 o'clock 6 cm from the nipple there is a oval hypoechoic mass which\nappears smaller than on the prior ultrasound and now measures 0.4 x 0.3 x 0.2\ncm, previously measured 0.4 x 0.4 x 0.3 cm. This is been stable or smaller\nfor ___ years and is benign. No further imaging follow-up is recommended.\n\nAt 8 o'clock 4 cm from the nipple there is an oval hypoechoic mass that is\nunchanged in size and measures 0.4 x 0.3 x 0.3 cm, previously this measured\n0.4 x 0.4 x 0.2 cm. This has been stable for ___ years and is benign. No\nfurther imaging follow-up is recommended. This mass likely corresponds to the\n0.5 cm asymmetry in the right breast at mid depth.\n\nAt 09:30 o'clock 3 cm from nipple there is a cluster of cysts that measures\nmaximally 0.9 cm in the transverse dimension and measures 0.7 x 0.6 x 0.3 cm\nin the radial and anti radial ___. This corresponds to the\nmacrolobulated mass in the anterolateral right breast. This is benign and no\nfurther imaging follow-up is recommended.\n\nAt 3 o'clock 3 cm from the nipple, there is a circumscribed anechoic simple\ncyst measuring 0.8 x 0.6 x 0.4 cm. This corresponds to the mammographic\nfinding in the lower inner right breast. This is benign and no further\nimaging follow-up is recommended.", + "output": "1. Multiple masses in the right breast are benign. No imaging follow-up is\nrecommended.\n2. No mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Return to annual screening mammography with tomosynthesis\nimaging.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "DIGITAL BILATERAL DIAGNOSTIC MAMMOGRAMS:\nThere are scattered areas of fibroglandular density. The previously seen\ncircumscribed mass in the posterior depth right upper inner quadrant is no\nlonger visualized consistent with prior resolution falling cyst aspiration. No\ndominant mass, suspicious microcalcifications or focal architecture distortion\nis seen in either breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right upper inner\nquadrant was performed. In the 1 o'clock 3 cm from the nipple there is an oval\nanechoic circumscribed mass which measures 2 mm in maximum ___ and\ndemonstrates good through transmission and no internal vascularity. This is in\nthe region of the previously aspirated cluster of cysts. No other solid or\ncystic mass is seen.", + "output": "No evidence of malignancy. 2 mm simple cyst at this site of prior cyst\naspiration without any suspicious features seen on imaging.\n\nRECOMMENDATION: Annual screening mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "DIGITAL BILATERAL DIAGNOSTIC MAMMOGRAMS:\nThere are scattered areas of fibroglandular density. The previously seen\ncircumscribed mass in the posterior depth right upper inner quadrant is no\nlonger visualized consistent with prior resolution falling cyst aspiration. No\ndominant mass, suspicious microcalcifications or focal architecture distortion\nis seen in either breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right upper inner\nquadrant was performed. In the 1 o'clock 3 cm from the nipple there is an oval\nanechoic circumscribed mass which measures 2 mm in maximum ___ and\ndemonstrates good through transmission and no internal vascularity. This is in\nthe region of the previously aspirated cluster of cysts. No other solid or\ncystic mass is seen.", + "output": "No evidence of malignancy. 2 mm simple cyst at this site of prior cyst\naspiration without any suspicious features seen on imaging.\n\nRECOMMENDATION: Annual screening mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Survey view of the transplanted kidney shows mild hydronephrosis, similar to\nthe previous exam from ___.", + "output": "Sonographic guidance for biopsy of the leftlower quadrant transplant kidney by\nnephrologist." + }, + { + "input": "RIGHT:\n\nThe right carotid vasculature has minimal atherosclerotic plaque.\n\nThe right common carotid artery had peak systolic/diastolic velocities of\n72/21 cm/sec.\n\nThe right internal carotid artery had peak systolic/diastolic velocities of\n60/26 cm/sec in its proximal portion, 64/21 cm/sec in its mid portion and\n56/23 cm/sec in its distal portion.\n\nThe external carotid artery has peak systolic velocity of 53cm/sec.\n\nThe vertebral artery has peak systolic velocity of 58 cm/sec with normal\nantegrade flow.\n\nThe right ICA/CCA ratio is 0.88.\n\nLEFT:\n\nThe left carotid vasculature has minimal atherosclerotic plaque.\n\nThe left common carotid artery had peak systolic/diastolic velocities of 84/20\ncm/sec.\n\nThe left internal carotid artery had peaks ystolic/diastolic velocities of\n100/44 cm/sec in its proximal portion, 105/48 cm/sec in its mid portion and\n105/42 cm/sec in its distal portion.\n\nThe external carotid artery has peak systolic velocity of 82cm/sec.\n\nThe vertebral artery has peak systolic velocity of 84 cm/sec with normal\nantegrade flow.\n\nThe left ICA/CCA ratio is 1.2.", + "output": "Less than 40% stenosis in the bilateral carotid arteries with minimal\natherosclerotic plaque." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 102 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 189, 151, and 110 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.9.\nThe external carotid artery has peak systolic velocity of 207 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 79, 102, and 79 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "60-69% stenosis of the right ICA.\n\nLess than 40% stenosis of the left ICA.\n\nNo significant change compared to ___." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mildly heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 150 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are ___, and 114 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 346 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 78, 105, and 88 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Bulky heterogeneous plaque noted proximal right internal carotid artery\nwith mild plaque involving the left internal carotid artery.\n\n2. 60-69% stenosis proximal right internal carotid artery with a less than\n40% stenosis left internal carotid artery.\n\n3. Bilateral pro grade flow vertebral arteries.\n\n4. These findings show no interval change since the most recent examination\nin ___ sixteen." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 174, 132, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 105 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 126 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 56, 111, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 57 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "___ 60-69% stenosis; LICA ___ stenosis.\nNo significant change from prior" + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 178, 145, and 115 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 2.9.\nThe external carotid artery has peak systolic velocity of 150 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 75, 100, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 1.8.\nThe external carotid artery has peak systolic velocity of 56 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nNo substantial change since ___", + "output": "60-69% stenosis of the right carotid system.\n\nLess than 40% stenosis of the left carotid system." + }, + { + "input": "RIGHT:\nThere is moderate to marked heterogenous atherosclerotic plaque in the right\ncarotid artery, greatest in the CCA and ECA.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 83.8 cm/s / 9.97 cm/s\nCCA Distal: 85 cm/s / 11.7 cm/s\nICA ___: 190 cm/s / 37.5 cm/s\nICA Mid: 203 cm/s / 25.4 cm/s\nICA Distal: 67.8 cm/s / 12.4 cm/s\nECA: 142 cm/s\nVertebral: 65.7 cm/s\n\nICA/CCA Ratio: 2.39\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 123 cm/s / 29.9 cm/s\nCCA Distal: 95.3 cm/s /\nICA ___: 44.8 cm/s / 6.29 cm/s\nICA Mid: 108 cm/s / 27.5 cm/s\nICA Distal: 98.6 cm/s / 17.5 cm/s\nECA: 62.8 cm/s\nVertebral: 32.4 cm/s\n\nICA/CCA Ratio: 1.13\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 60-69% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 93, 82, and 80 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 22\ncm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 85 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 125, 121, and 71 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 28\ncm/sec.\nThe ICA/CCA ratio is 1.9.\nThe external carotid artery has peak systolic velocity of 100 cm/sec.\nThe vertebral artery is patent with to and fro flow.\nThere is decreased amplitude of the left brachial artery waveform.\n\nOf note, the patient is status post bilateral carotid endarterectomies.", + "output": "Right ICA <40% stenosis.\nLeft ICA 40-59% stenosis.\n\nDampening of the left brachial artery waveform suggesting left subclavian\nsteno-occlusive disease." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nThere is a partially circumscribed mass in the right upper central quadrant.\nAdjacent to the BB marking the site of clinical concern. This on same day\nultrasound corresponds to a simple cyst in the 12 o'clock. There is no \nunexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper central quadrant was scanned. In the 12 o'clock 2 cm from the\nnipple there is an anechoic ovoid circumscribed mass which measures 1.2 x 0.7\nx 1.1 cm and demonstrates good through transmission and no internal\nvascularity. This is palpable to the patient. In the retroareolar region there\nis a similar anechoic circumscribed mass which measures 2.5 at 1.2 x 2.1 cm\nand demonstrates good through transmission and no internal vascularity. Both\nmasses are consistent with simple cysts.", + "output": "No evidence of malignancy. Simple cysts in the right breast with this cyst in\nthe 12 o'clock corresponding to the patient's palpable concern.\n\nRECOMMENDATION: Final disposition of patient's symptoms should be based on\nclinical grounds. Age and risk appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nThere is a partially circumscribed mass in the right upper central quadrant.\nAdjacent to the BB marking the site of clinical concern. This on same day\nultrasound corresponds to a simple cyst in the 12 o'clock. There is no \nunexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper central quadrant was scanned. In the 12 o'clock 2 cm from the\nnipple there is an anechoic ovoid circumscribed mass which measures 1.2 x 0.7\nx 1.1 cm and demonstrates good through transmission and no internal\nvascularity. This is palpable to the patient. In the retroareolar region there\nis a similar anechoic circumscribed mass which measures 2.5 at 1.2 x 2.1 cm\nand demonstrates good through transmission and no internal vascularity. Both\nmasses are consistent with simple cysts.", + "output": "No evidence of malignancy. Simple cysts in the right breast with this cyst in\nthe 12 o'clock corresponding to the patient's palpable concern.\n\nRECOMMENDATION: Final disposition of patient's symptoms should be based on\nclinical grounds. Age and risk appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense and nodular\nwhich lowers mammographic sensitivity and may obscure detection of small\nmasses.\n\nRight breast: A BB marker is placed over the right upper central breast\nmarking the area of clinical concern. A partially circumscribed mass is seen\nin the right central breast at posterior depth. The right breast was further\nassessed with ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nLeft breast:There is no suspicious dominant mass, unexplained architectural\ndistortion or suspicious grouped calcifications. Parenchymal pattern is\nstable.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right upper outer breast\nwas performed. In the area of patient directed palpable abnormality and pain\nat the 12 o'clock position 0-1 cm from the nipple, there is a 1.4 x 0.4 x 1.1\ncm anechoic well-circumscribed simple cyst.\n\nAt 11 o'clock 0-1 cm from nipple, there is a well-circumscribed 0.9 x 0.9 x\n0.8 cm simple cyst. The 9 o'clock retroareolar region demonstrates a\nwell-circumscribed anechoic cyst measuring 1.7 x 0.8 x 0.9 cm, likely\ncorresponding to the right breast mammographic findings, and appears similar\nto the prior right breast ultrasound performed ___.", + "output": "No specific evidence of malignancy in either breast. Multiple right breast\ncysts. Co\n\nRECOMMENDATION(S): Final disposition of the patient symptoms should be based\non clinical grounds. Age and risk appropriate screening is also recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense and nodular\nwhich lowers mammographic sensitivity and may obscure detection of small\nmasses.\n\nRight breast: A BB marker is placed over the right upper central breast\nmarking the area of clinical concern. A partially circumscribed mass is seen\nin the right central breast at posterior depth. The right breast was further\nassessed with ultrasound. There is no unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nLeft breast:There is no suspicious dominant mass, unexplained architectural\ndistortion or suspicious grouped calcifications. Parenchymal pattern is\nstable.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right upper outer breast\nwas performed. In the area of patient directed palpable abnormality and pain\nat the 12 o'clock position 0-1 cm from the nipple, there is a 1.4 x 0.4 x 1.1\ncm anechoic well-circumscribed simple cyst.\n\nAt 11 o'clock 0-1 cm from nipple, there is a well-circumscribed 0.9 x 0.9 x\n0.8 cm simple cyst. The 9 o'clock retroareolar region demonstrates a\nwell-circumscribed anechoic cyst measuring 1.7 x 0.8 x 0.9 cm, likely\ncorresponding to the right breast mammographic findings, and appears similar\nto the prior right breast ultrasound performed ___.", + "output": "No specific evidence of malignancy in either breast. Multiple right breast\ncysts. Co\n\nRECOMMENDATION(S): Final disposition of the patient symptoms should be based\non clinical grounds. Age and risk appropriate screening is also recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Transverse and sagittal grayscale images as well as color/spectral Doppler\nimages were obtained of the superficial tissues of the penis.\n\nThe bilateral corpora cavernosa appear intact and within normal limits. \nCorpus spongiosum appears within normal limits. There is no suggestion of\nsurrounding hematoma. He now vascularity is within normal limits, with normal\narterial and venous spectral waveforms of the dorsal artery and vein.", + "output": "Normal ultrasound appearance of the penis without evidence of fracture or\nsurrounding hematoma." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 62 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 89, 74, and 62 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 20\ncm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 43 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 72 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 91, 105, and 101 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 23\ncm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 43 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, a 16 gauge core biopsy needle was then advanced into the liver and a\nsingle core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 100 mcg fentanyl throughout the total intra-service time of\n14 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a trace\namount of ascites in the right lower quadrant. The sole pocket in the right\nlower quadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 20 gauge needle was advanced into the fluid pocket in the right lower\nquadrant under direct ultrasound guidance. No fluid was successfully\naspirated despite repeated attempts.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ performed the key components of the procedure and reviewed and\nagrees with the trainee's findings.", + "output": "Attempted ultrasound-guided diagnostic paracentesis. No fluid could be\naspirated." + }, + { + "input": "The upper abdominopelvic wall fluid collection is decreased in size compared\nto the CT obtained 6 days prior. The lower abdominopelvic wall fluid\ncollection is minimally changed. Aspiration of both collections yielded\nserosanguineous fluid.", + "output": "Successful US-guided aspiration of the upper abdominopelvic wall fluid\ncollection and placement of ___ pigtail catheter into the lower\nabdominopelvic wall fluid collection. Samples were sent for microbiology\nevaluation." + }, + { + "input": "Targeted ultrasound of the right retroareolar region is unremarkable without\nductal dilatation. Complete right breast ultrasound was performed of all 4\nquadrants and the right axilla. The breast tissue is heterogeneously dense\nwith heterogeneous echotexture. There is no discrete solid or cystic mass\nidentified within the right breast. Scanning of the right axilla demonstrates\nnormal appearance of axillary lymph nodes.", + "output": "No ultrasound evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Consider screening breast ultrasound, age ___, given\nthat the patient is unable to participate for a mammogram.\n\nNOTIFICATION: Findings reviewed with the patient and her mother at the\ncompletion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Targeted sonographic examination of the right upper breast was performed with\nspecific attention to the 1 o'clock region, where there is a reported lump. \nThere is a mark on the patient's skin in this region. No discrete cystic or\nsolid mass is seen.", + "output": "Normal targeted ultrasound.\n\nRECOMMENDATION(S): Clinical follow-up for any persistent clinical findings.\n\nNOTIFICATION: Findings reviewed with the patient's caregivers and referring\nclinician at the completion of the study. ___, NP, examined the\npatient following this study in our department.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and nodular\nwhich may obscure detection of small masses.\nThere are grouped coarse heterogeneous calcifications in the lower inner right\nbreast at posterior depth which are indeterminate and for which stereotactic\ncore biopsy is recommended. The asymmetry in the right retroareolar region\ndoes not persist on spot compression views and is compatible with superimposed\nfibroglandular tissue. Ultrasound was performed given the breast density. \nThere is no architectural distortion in the right breast.\n\nBILATERAL BREAST ULTRASOUND:\n\nTargeted ultrasound was performed of the right lateral breast from ___\no'clock 0-4 cm from the nipple in the area of the previously described\nasymmetry. Prominent ducts were identified but no suspicious solid or cystic\nmass was identified. Targeted ultrasound was also performed of the right\nmedial breast in the area of pain as indicated by the patient from ___ o'clock\n1-12 cm from the nipple. No suspicious solid or cystic mass was identified.\n\nTargeted ultrasound was performed of the left medial breast in the area of\npain. At 8 o'clock 9 cm from the nipple there is a 0.6 x 0.4 x 0.6 cm\nhypoechoic, parallel mass without significant internal vascularity or\nposterior shadowing. This may be in continuity with a duct.", + "output": "1. Indeterminate calcifications in the right breast for which stereotactic\ncore biopsy was recommended.\n2. Probably benign mass in the left breast at 8 o'clock in the area of pain. \nThe option of six-month follow-up versus ultrasound-guided biopsy was\ndiscussed with the patient who prefers ultrasound-guided biopsy at this time.\n\nRECOMMENDATION(S): Right breast stereotactic core biopsy and left breast\nultrasound-guided core biopsy.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\nFindings were entered into the critical results dashboard for direct\ncommunication with the referring clinician.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "In the left breast at 8 o'clock, 9 cm from the nipple there is an oval,\ncircumscribed, hypoechoic, parallel mass with no internal vascularity or\nposterior features. This was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "In the left breast at 8 o'clock, 9 cm from the nipple there is an oval,\ncircumscribed, hypoechoic, parallel mass with no internal vascularity or\nposterior features. This was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nRight common femoral artery: Vessel caliber is somewhat narrow. There is\nsuspicion of vasospasm. There is filling of the distal territory though\nsomewhat delayed. Plan for follow-up angiogram at the end of the case.\n\nLeft internal carotid artery: Vessel caliber smooth and regular. There is\nopacification of the anterior and middle cerebral arteries and their distal\nterritories. There is cross-filling across the anterior communicating artery\nand filling of the contralateral A 2 segment. There is a fetal configuration\nto the PC OM. There is supply the retinal blush. There is no evidence\nanastomosis to the external carotid artery. There is evidence of known\nleft-sided shift related to her known subdural hematoma.\n\nLeft common carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral arteries and their distal\nterritories. There is filling the distal external carotid artery branches. \nThere is no clear anastomosis between the internal and external carotid\narteries.\n\nLeft external carotid artery: There is opacification the distal external\ncarotid artery branches. There is no evidence of mass stenosis between the\ninternal and external carotid arteries. There is a reasonable middle\nmeningeal artery target.\n\nLeft middle meningeal artery micro injection there is filling of the posterior\nmiddle meningeal artery the later in the phase the anterior branch. There is\nno evidence of anastomosis to the internal carotid artery.\n\nLeft common carotid artery after embolization: No residual filling of the\nmiddle meningeal artery. Additional external carotid artery branches remain\npatent. The internal carotid artery circulation is intact.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device. Improvement the caliber the vessel compared\nto the preprocedure run.", + "output": "Uncomplicated embolization of the left middle meningeal artery for subdural\nhematoma\n\nRECOMMENDATION(S):\n1." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4025cc of serosanguineousfluid was removed, with the 25 cc\nsent for the requested laboratory analysis.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, personally supervised the procedure,\nsubsequently reviewing and has agreed with the preliminary findings.", + "output": "Uneventful diagnostic and therapeutic paracentesis yielding 4025cc of\nserosanguineous ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5 L of serosanguineousfluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, personally supervised the procedure,\nsubsequently reviewing and has agreed with the preliminary findings.", + "output": "Uneventful therapeutic paracentesis yielding 5 L of serosanguineous ascitic\nfluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ ___ catheter was advanced into the largest fluid pocket in the\nright lower quadrant and 3 L of translucent, red-yellow ascites fluid was\nremoved. Specimen sent for laboratory analysis per referring physician.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ was present for and personally supervised the entirety of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated ultrasound-guided diagnostic and therapeutic paracentesis via a\nright lower quadrant approach yielding 3 L of translucent, red-yellow ascites\nfluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.6 L of serosanguinousfluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Uneventful therapeutic paracentesis yielding 2.6 L of serosanguineous ascitic\nfluid." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 142 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 45, 57, and 63 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.47.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild-to-moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 105 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 43, 71, and 53 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.74.\nThe external carotid artery has peak systolic velocity of 98 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild-to-moderate calcified atherosclerotic plaque within the carotid arteries\nbilaterally with no significant, flow limiting stenosis. The vertebral\narteries are patent with antegrade flow." + }, + { + "input": "Focused study did not demonstrate any evidence of hernia solid or cystic\nmasses, the study was performed with and without Valsalva", + "output": "No evidence of hernia or masses" + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nNo persistent architecture distortion is seen at the area questioned on the\nscreening mammogram. Asymmetry in the right lower central/inner breast\nappears pliable without underlying mass on spot compression. Given the\nheterogeneous dense breast parenchyma, a targeted ultrasound was performed. .\n\nRIGHT BREAST ULTRASOUND:\n\nThe retroareolar and right lower central and lower inner quadrant was scanned.\nNormal breast parenchyma is identified. No solid or cystic mass is seen. No\nabnormal vascularity seen.", + "output": "No persistent abnormality. No evidence of malignancy.\n\nRECOMMENDATION: Age and risk appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 120 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 78, 56, and 82 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.65.\nThe external carotid artery has peak systolic velocity of 120 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 112 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 89, 75, and 78 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 0.79.\nThe external carotid artery has peak systolic velocity of 115 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the bilateral internal carotid arteries." + }, + { + "input": "Corresponding to the patient's known hemorrhagic cyst in the left renal pelvis\nis a 4.0 x 4.6 cm heterogeneously hypoechoic complex cyst with internal echoes\nand no internal vascularity.This measured up to 5.3 cm on the MRI on\n___.", + "output": "Successful US-guided aspiration of the hemorrhagic left renal cyst. Only a\nsmall amount of clot and 3 cc of dark, hemorrhagic material could be\naspirated. This was sent for culture." + }, + { + "input": "RIGHT:\nCalcified plaque is seen at the origin of the right ICA.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 119, 112, and 150 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 65 cm/sec.\nThe ICA/CCA ratio is 2.58.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nCalcified plaque is also seen at the origin of the left ICA.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 114, 112, and 113 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 38 cm/sec.\nThe ICA/CCA ratio is 1.35.\nThe external carotid artery has peak systolic velocity of 107 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Calcified plaque at the origin of the right ICA. Stenosis in the right ICA\nis at least moderate (40-59%), borderline for moderately-severe.\n2. Calcified plaque is also noted at the origin of the left ICA. Moderate\nstenosis 40-59% in the left ICA." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 82 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 55, 80, and 102 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 67 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 59, 76, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of carotid artery stenosis bilaterally. No evidence of\natherosclerotic plaque in the bilateral carotid arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 56 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 69, 70, and 88 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 27\ncm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 94, 72, and 68 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 22\ncm/sec.\nThe ICA/CCA ratio is 1 point.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.5 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.5 L of fluid were removed from the right lower quadrant." + }, + { + "input": "Anteverted and anteflexed uterus measures 5.7 x 8.4 cm on the sagittal images.\nEndometrium measures 8 mm in width. The right ovary measures 1.9 x 2.0 x 3.9\non the transvaginal images. Left ovary is visualized only on the\ntransabdominal images where it measures 2.9 x 1.2 x 2.9 cm, probably owing to\nits fairly high position in the pelvis. Left ovary also appears normal. Each\novary demonstrates appropriate presence of color flow. Trace free fluid is\nwithin physiological range.", + "output": "Normal study." + }, + { + "input": "1. Postprocedure images of the right submandibular gland were performed\ndemonstrating a minimally enlarged gland. The right submandibular gland was\nselected for biopsy.\n2. 5 core biopsy samples were taken with an 18 gauge biopsy device. The\npatient tolerated the procedure well and there were no immediate postprocedure\ncomplications.", + "output": "Successful biopsy of the right submandibular gland. Samples were sent to\npathology and there were no immediate postprocedure complications." + }, + { + "input": "As preprocedure ultrasound was performed. The right kidney is 11.5 cm and the\nleft kidney is 10.6 cm, both normal in size and echogenicity without\nhydronephrosis, stone, or mass identified.\n\nReal-time ultrasound guidance for non targeted left renal biopsy was provided\nby the Radiology service for the Nephrology service.", + "output": "Real-time ultrasound guidance provided to the Nephrology service for non\ntargeted left renal biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 55 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 63, 63, and 59 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 93 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 84, 44, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 94 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of hemodynamically significant carotid artery stenosis (<40%,\nbilaterally)." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 96 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 51 cm/s, 57 cm/s, and 71 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 0.74.\nThe external carotid artery has peak systolic velocity of97 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 81 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 59 cm/s, 52 cm/s, and 54 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 0.73.\nThe external carotid artery has peak systolic velocity of 96 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the left internal carotid artery.\nNormal right internal carotid artery." + }, + { + "input": "Sagittal and transverse images of the manubrium and sternomanubrial junction\nwere obtained. There is no sonographic evidence of an expansile osseous\nlesion. The anterior cortex appears intact. Chronic degenerative changes are\nnoted at the sternomanubrial junction with mild osteophyte formation. No\nnearby soft tissue mass is identified. The patient reported pain with\napplication of mild pressure from the transducer directly over the\nsternomanubrial junction.", + "output": "Mild degenerative changes at the sternomanubrial junction without evidence of\nosseous or soft tissue mass." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque in the distal\nright common carotid artery.\nThe peak systolic velocity in the right common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 72, 56, and 53 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 117 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 74, 73, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 124 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild stenosis (less than 40%) in the right internal carotid artery\nNormal left internal carotid artery (0% stenosis)" + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications in either breast. In particular there is no\ndiscrete mass seen at the location of the right BB. Vascular calcifications\nare noted bilaterally. A few scattered benign calcifications are seen in the\nleft medial breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right medial inferior\nbreast was performed from 3 o'clock through 6 o'clock with attention to the\n___ o'clock area 6-8 cm from the nipple at the patient's area of concern. \nThere is no suspicious solid or cystic mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Clinical followup for any areas of palpable abnormality.\nAnnual mammography.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications in either breast. In particular there is no\ndiscrete mass seen at the location of the right BB. Vascular calcifications\nare noted bilaterally. A few scattered benign calcifications are seen in the\nleft medial breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right medial inferior\nbreast was performed from 3 o'clock through 6 o'clock with attention to the\n___ o'clock area 6-8 cm from the nipple at the patient's area of concern. \nThere is no suspicious solid or cystic mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Clinical followup for any areas of palpable abnormality.\nAnnual mammography.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Large hypoechoic peritoneal fluid collection within the anterior abdominal\ncavity.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples were sent for requested evaluation." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA 1.7 cm mass is noted in the upper outer right breast. An asymmetry in the\nupper outer left breast has the appearance of normal breast tissue on\nadditional imaging performed today. Both areas were scanned with ultrasound P\n\nLEFT BREAST ULTRASOUND: The upper-outer left breast was scanned. No\nabnormality is identified.\n\nRIGHT BREAST ULTRASOUND: At ___ o'clock 8 cm from the nipple there is a 1.8\nx 0.9 x 1.4 cm macro lobulated hypoechoic mass. This correlates well with the\nmammographic finding. This also corresponds to the palpable area.", + "output": "Area of clinical concern in the right breast correlates with an indeterminate\nmass that likely represents a benign entity such as fibroadenoma.\n\nRECOMMENDATION(S): Biopsy is recommended as the mass cannot be definitively\ncharacterized as a fibroadenoma based on imaging.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Findings were also be e-mail to Dr. ___ by Dr. ___ at the time\nof the study.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Targeted ultrasound of the right breast at the 10 o'clock position,\napproximately 6 cm from the nipple demonstrated a 1.8 cm hypoechoic mass.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___. The procedure was supervised by ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ In ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted ultrasound of the right breast at the 10 o'clock position,\napproximately 6 cm from the nipple demonstrated a 1.8 cm hypoechoic mass.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___. The procedure was supervised by ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ In ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "The left common femoral artery is patent with wall to wall Doppler flow. left\ncommon femoral artery is patent with arterial waveform.\n\nThe superficial FA and deep FA appear patent with wall to wall flow. The deep\nfemoral artery branches appear patent with normal flow. The left superficial\nfemoral artery is patent with wall to wall Doppler flow and arterial waveform.\n\nThe left common femoral vein is patent, has venous waveforms and has\nwall-to-wall flow.\nThe left superficial femoral vein is patent, with venous waveforms, with wall\nto wall flow.\n\nNo evidence of pseudoaneurysm.", + "output": "Patent left femoral arteries without evidence of pseudoaneurysm." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 20 ml of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. Fluid was submitted to the laboratory." + }, + { + "input": "The aorta measures 2.1 cm in the proximal portion, 2.0 cm in mid portion and\n1.8 cm in the distal abdominal aorta. There is moderate calcified\natherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe common iliac arteries were not visualized.\n\nLimited views of the kidneys are notable for large left renal collecting\nsystem, better demonstrated on prior CT.", + "output": "1. No evidence of abdominal aortic aneurysm." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe asymmetry in the right inferior breast is pliable on spot compression\nviews and likely corresponds to reduction surgery. There are no spiculated\nmasses suspicious clustered microcalcifications or unexplained areas of\narchitectural distortion.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast over the\narea of skin discoloration was performed at 7 o'clock and no discrete solid or\ncystic mass is seen the right breast was scanned from ___ o'clock.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION: Final disposition of the skin discoloration should be based\non clinical evaluation. If this persists of dermatology referral could be\nobtained. Annual mammography recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 71 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 89 cm/s, 100 cm/s, and 88 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of77 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 83 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 58 cm/s, 91 cm/s, and 101 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 40 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 76 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nLeft vertebral artery: Vessel caliber smooth and regular. There is\nopacification the basilar artery as well as bilateral posterior cerebral\narteries and bilateral superior cerebellar arteries. There is evidence of\ncompetitive flow from the contralateral vertebral artery. There are\nsignificant collaterals via the distal PCA and PCOM to the anterior\ncirculation bilaterally, more prominent on the left. No evidence of aneurysm\nor AVM. The venous phase is unremarkable.\n\nRight internal carotid artery: Vessel caliber is smooth. There is evidence of\ncarotid stenosis at the supraclinoid ICA. There is opacification of the\nanterior and middle cerebral arteries. There is evidence of competitive flow\nin the MCA likely from posterior circulation collateral vessels. There is\nfaint filling of the A2 segment. There is no evidence of aneurysm or AVM. \nThe venous phase is unremarkable.\n\nRight common carotid artery: There is filling of the distal external carotid\nartery branches. There is some trans osseous scalp vessels the anastomosis\nintracranially. There is a reasonable superficial temporal artery. There is\nno evidence of carotid stenosis in the cervical region based on roadmap images\nand NASCET criteria.\n\nLeft common carotid artery: There is evidence of supraclinoid ICA stenosis. \nThere is filling of the A1 segment and filling of the bilateral A2 segments. \nThere is no clear M1. There is abrupt cutoff of the MCA. There are some\ntufts of vessels consistent with moyamoya. There is a reasonable superficial\ntemporal artery. There is no evidence of aneurysm or AVM. The venous phase\nis unremarkable.\n\nRight common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "Bilateral moyamoya disease, ___ class 3 on the right and class 4 on the\nleft. There is bilateral supraclinoid ICA stenosis and complete occlusion of\nthe left MCA. There is significant collaterals in the posterior circulation. \nThere are reasonable superficial temporal arteries bilaterally.\n\nRECOMMENDATION(S):\n1. Will discuss the treatment options at vascular conference and contact\npatient" + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and nodular\nwhich may obscure detection of small masses.\n\nThe previously described asymmetry in the right upper breast at posterior\ndepth is compressible and changeable with differences in positioning favoring\nasymmetric breast tissue. However, due to the density of the breast tissue,\nultrasound was undertaken to exclude an underlying lesion.\n\nThe previously described asymmetry in the left upper breast does not persist\non additional views, and therefore is felt to have represented overlapping\nfibroglandular tissue.\n\nUltrasound of the right upper breast from ___ o'clock to 14 cm from the nipple\nin the area of mammographic concern was performed. No suspicious solid or\ncystic mass is seen.", + "output": "1. Probable benign right breast asymmetry favoring asymmetric breast tissue. \nFollow-up mammography in 6 months seems reasonable at this time.\n2. Left breast asymmetry on recent screening mammogram dated ___\ncorresponding to superimposed breast tissue.\n\nRECOMMENDATION(S): Six-month follow-up right diagnostic mammogram with\ntomosynthesis.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and nodular\nwhich may obscure detection of small masses.\n\nThe previously described asymmetry in the right upper breast at posterior\ndepth is compressible and changeable with differences in positioning favoring\nasymmetric breast tissue. However, due to the density of the breast tissue,\nultrasound was undertaken to exclude an underlying lesion.\n\nThe previously described asymmetry in the left upper breast does not persist\non additional views, and therefore is felt to have represented overlapping\nfibroglandular tissue.\n\nUltrasound of the right upper breast from ___ o'clock to 14 cm from the nipple\nin the area of mammographic concern was performed. No suspicious solid or\ncystic mass is seen.", + "output": "1. Probable benign right breast asymmetry favoring asymmetric breast tissue. \nFollow-up mammography in 6 months seems reasonable at this time.\n2. Left breast asymmetry on recent screening mammogram dated ___\ncorresponding to superimposed breast tissue.\n\nRECOMMENDATION(S): Six-month follow-up right diagnostic mammogram with\ntomosynthesis.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The heterogeneous lesion for biopsy was identified in the right\nlobe measuring approximately 11.9 x 9.1 x 10.2 cm. A suitable approach for\ntargeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a 17 gauge coaxial needle was introduced\ninto the right lobe lesion. Under ultrasound visualization, four 18 gauge core\nbiopsy specimens were obtained. Samples were provided to the on-site\ncytologist who indicated an adequate sample. 3 samples were submitted to\ncytology. 1 sample was submitted for microbiology. 2 fine needle aspirates\nwere performed utilizing a 22 gauge needle and submitted in CytoLyt.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: The patient received 50 mcg fentanyl intravenously throughout the\ntotal intra-service time of 31 minutes during which patient's hemodynamic\nparameters were continuously monitored by an independent trained radiology\nnurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 4, with 3 specimens provided to\nthe cytologist. 1 sample was submitted for microbiology. Two 22 gauge\nfine-needle aspirates were submitted in CytoLyt.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 4:35 ___, 10 minutes after procedure completion." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the right kidney was targeted and 3 biopsy\npasses performed.\n\nSEDATION: None.", + "output": "Ultrasound guidance for percutaneous right kidney biopsy." + }, + { + "input": "There is no appreciable plaque or wall thickening involving either carotid\nsystem. The peak systolic velocities as well as the ICA to CCA ratios are\nnormal bilaterally. There is normal antegrade flow involving both vertebral\narteries.", + "output": "Normal duplex and color Doppler assessment of both carotid systems." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na total of 3 (three) core biopsy samples were obtained. 1 sample was placed\nin formalin. Two additional samples were placed in saline, for microbiology\nand future PCR evaluation, per request by the ordering provider. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n0.5 mg Versed and 25 mcg fentanyl throughout the total intra-service time of\n15 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy. A total of three core biopsies were\nobtained, one placed in formalin, with two additional samples placed in saline\nfor microbiology and additional PCR evaluation, as requested." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 50, 66, and 80 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 33\ncm/sec.\nThe ICA/CCA ratio is 1.1..\nThe external carotid artery has peak systolic velocity of 60 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 15, 68, and 78. Cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 33\ncm/sec.\nThe ICA/CCA ratio is 0.73..\nThe external carotid artery has peak systolic velocity of 90 C cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 5\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 1 L of green-yellow fluid\nSamples: Fluid samples were submitted to the laboratory for the requested\nanalysis.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1 L of fluid were removed and sample sent for analysis." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is re- demonstration of a low density 0.8 cm mass in the central outer\nposterior right breast. There is the suggestion of a lucent fatty hilum on a\n90 degree lateral spot Mag view. However, ultrasound was performed.\n\nRIGHT BREAST ULTRASOUND: At 9 o'clock 4 cm from the nipple there is a 0.5 x\n0.3 x 0.7 cm mass that has the appearance of a cluster of microcysts. There\nis no internal vascularity. This likely correlates with the mammographic\nfinding.", + "output": "Probably benign mass seen on mammography likely correlates with a probable\ngroup of microcysts on ultrasound.\n\nRECOMMENDATION(S): Six-month followup right breast mammogram and ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously described 0.8 cm mass in the central, outer, posterior depth\nright breast has almost completely resolved. No new suspicious mass,\nunexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast was performed. At\n9 o'clock, 4 cm from the nipple, the previously described cluster of\nmicrocysts has markedly decreased in size, now measuring up to 2 mm in\ngreatest dimension. No new suspicious solid or cystic lesion detected in this\nregion.", + "output": "1. Markedly decreased size of the previously described cluster of microcysts\nin the right breast at 9 o'clock. No new suspicious solid or cystic lesion.\n\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Annual mammogram due in ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously described 0.8 cm mass in the central, outer, posterior depth\nright breast has almost completely resolved. No new suspicious mass,\nunexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast was performed. At\n9 o'clock, 4 cm from the nipple, the previously described cluster of\nmicrocysts has markedly decreased in size, now measuring up to 2 mm in\ngreatest dimension. No new suspicious solid or cystic lesion detected in this\nregion.", + "output": "1. Markedly decreased size of the previously described cluster of microcysts\nin the right breast at 9 o'clock. No new suspicious solid or cystic lesion.\n\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Annual mammogram due in ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is an asymmetry in the lateral left breast which persists with spot\ncompression view. Otherwise, there is no suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. At the 3 o'clock to\nthe 4 o'clock position of the left breast 9 cm from the nipple, corresponding\nto the mammographic asymmetry, there is a normal appearing intramammary lymph\nnode without evidence of cortical thickening. There is no suspicious solid or\ncystic mass.", + "output": "No specific mammographic evidence of malignancy. Left breast intramammary\nlymph node is benign.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is an asymmetry in the lateral left breast which persists with spot\ncompression view. Otherwise, there is no suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. At the 3 o'clock to\nthe 4 o'clock position of the left breast 9 cm from the nipple, corresponding\nto the mammographic asymmetry, there is a normal appearing intramammary lymph\nnode without evidence of cortical thickening. There is no suspicious solid or\ncystic mass.", + "output": "No specific mammographic evidence of malignancy. Left breast intramammary\nlymph node is benign.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Subcutaneous mass within the medial distal right thigh. This is unchanged in\nappearance compared to the prior ultrasound dated ___, size\nestimated at 3.1 x 1.7 x 3.7 cm.", + "output": "1. Subcutaneous mass within the medial distal right thigh.\n2. Technically successful ultrasound guided percutaneous biopsy" + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 52 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 58, 53, and 34 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 17 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 91 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 61, 69, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 85 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous atherosclerotic plaque of the bilateral extracranial\ninternal carotid arteries. No significant stenosis (less than 40%)\nbilaterally." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 9\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 10 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "The right common femoral, superficial femoral and popliteal arteries are\npatent. Velocities range from 180 at the common femoral artery to 193 in the\nsuperficial femoral artery. There is a patent stent in the right superficial\nfemoral artery at its proximal segment.", + "output": "Patent right superficial femoral artery stent and vessels." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous calcified atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 70 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 35, 63, and 77 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 24\ncm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 159 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous calcified atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 56 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 62, 84, and 81 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 35\ncm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 87 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "The aorta measures 2.3 cm in the proximal portion, 2.0 cm in mid portion and\n1.8 cm in the distal abdominal aorta. There is mild calcified atherosclerotic\nplaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.3 cm and the left common iliac artery\nmeasures 1.2 cm.\n\nThe right kidney measures 9.6 cm and the left kidney measures 10.3 cm. Limited\nviews of the kidneys are unremarkable without hydronephrosis.", + "output": "Atherosclerotic aorta however no aneurysm visualized." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 70, 87, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 67.7 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 67, 77, and 80 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 62.7 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the bilateral internal carotid arteries." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM:\nTissue density: B - There are scattered areas of fibroglandular density.\nA 1.0 x 1.0 x 1.6 cm oval mass with micro lobulated borders in the upper outer\nleft breast persists on spot compression views and is further evaluated with\nultrasound. A 0.5 x 0.6 x 0.6 cm round circumscribed mass in the anterior\nupper slightly outer right breast is pliable on spot compression views and the\narea is further evaluated with ultrasound. No suspicious calcifications are\nassociated with either mass.\n\nBILATERAL BREAST ULTRASOUND: Targeted ultrasound of the left breast at 1\no'clock, 5 cm from the nipple demonstrates a 1.4 x 0.4 x 1.1 cm oval\ncircumscribed hypoechoic mass without internal vascularity or posterior\nfeatures, felt to correspond to the mass seen on mammogram. Evaluation of the\nleft axilla demonstrates morphologically normal appearing lymph nodes with\nnormal cortical thickness.\n\nTargeted ultrasound of the right breast at 11 o'clock, 2 cm from the nipple\ndemonstrates a 0.6 x 0.6 x 0.4 cm circumscribed, hypoechoic mass without\ninternal vascularity or posterior features, felt to correspond to the mass\nseen on mammogram. Evaluation of the right axilla demonstrates\nmorphologically normal appearing lymph nodes with normal cortical thickness.", + "output": "1.6 cm left breast mass and 0.6 cm right breast mass. The patient's son will\nattempt to obtain prior imaging to determine if these are stable and will\ncontact our department to issue an addendum. If prior imaging cannot be\nobtained to document stability, ultrasound-guided core biopsy of both the\nright and the left breast masses is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of left breast mass at 1\no'clock and right breast mass at 11 o'clock, if prior imaging cannot be\nobtained to document stability. The patient is on Coumadin, which will need\nto be stopped 5 days prior to the procedure if clinically safe to do so.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed by Dr.\n___ with the patient and her son, who agree with this plan. She was given\ninformation to schedule her biopsy.\n\n The findings and recommendation were emailed by Dr. ___ with Dr.\n___ on ___ at 1:02 ___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM:\nTissue density: B - There are scattered areas of fibroglandular density.\nA 1.0 x 1.0 x 1.6 cm oval mass with micro lobulated borders in the upper outer\nleft breast persists on spot compression views and is further evaluated with\nultrasound. A 0.5 x 0.6 x 0.6 cm round circumscribed mass in the anterior\nupper slightly outer right breast is pliable on spot compression views and the\narea is further evaluated with ultrasound. No suspicious calcifications are\nassociated with either mass.\n\nBILATERAL BREAST ULTRASOUND: Targeted ultrasound of the left breast at 1\no'clock, 5 cm from the nipple demonstrates a 1.4 x 0.4 x 1.1 cm oval\ncircumscribed hypoechoic mass without internal vascularity or posterior\nfeatures, felt to correspond to the mass seen on mammogram. Evaluation of the\nleft axilla demonstrates morphologically normal appearing lymph nodes with\nnormal cortical thickness.\n\nTargeted ultrasound of the right breast at 11 o'clock, 2 cm from the nipple\ndemonstrates a 0.6 x 0.6 x 0.4 cm circumscribed, hypoechoic mass without\ninternal vascularity or posterior features, felt to correspond to the mass\nseen on mammogram. Evaluation of the right axilla demonstrates\nmorphologically normal appearing lymph nodes with normal cortical thickness.", + "output": "1.6 cm left breast mass and 0.6 cm right breast mass. The patient's son will\nattempt to obtain prior imaging to determine if these are stable and will\ncontact our department to issue an addendum. If prior imaging cannot be\nobtained to document stability, ultrasound-guided core biopsy of both the\nright and the left breast masses is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of left breast mass at 1\no'clock and right breast mass at 11 o'clock, if prior imaging cannot be\nobtained to document stability. The patient is on Coumadin, which will need\nto be stopped 5 days prior to the procedure if clinically safe to do so.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed by Dr.\n___ with the patient and her son, who agree with this plan. She was given\ninformation to schedule her biopsy.\n\n The findings and recommendation were emailed by Dr. ___ with Dr.\n___ on ___ at 1:02 ___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the 1 o'clock position of the left breast, approximately 5 cm from the\nnipple, there is a 1.4 x 0.5 x 1.2 cm oval hypoechoic mass.\n\nIn the 12 o'clock position of the right breast, approximately 2 cm from the\nnipple, there is a 0.6 x 0.4 x 0.6 cm oval irregular hypoechoic mass.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD ___, M.D.. The procedure was\nsupervised by ___, M.D.(Attending).\n\nDescription:\nLEFT BREAST: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nRIGHT BREAST: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm placement of the left\nbiopsy clip 7 mm anterolateral to the mass. CC and lateral views confirm\nplacement of the right biopsy clip immediately adjacent to the mass.", + "output": "Technically successful US-guided core biopsy of the right and left breast\nlesions. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the 1 o'clock position of the left breast, approximately 5 cm from the\nnipple, there is a 1.4 x 0.5 x 1.2 cm oval hypoechoic mass.\n\nIn the 12 o'clock position of the right breast, approximately 2 cm from the\nnipple, there is a 0.6 x 0.4 x 0.6 cm oval irregular hypoechoic mass.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD ___, M.D.. The procedure was\nsupervised by ___, M.D.(Attending).\n\nDescription:\nLEFT BREAST: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nRIGHT BREAST: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm placement of the left\nbiopsy clip 7 mm anterolateral to the mass. CC and lateral views confirm\nplacement of the right biopsy clip immediately adjacent to the mass.", + "output": "Technically successful US-guided core biopsy of the right and left breast\nlesions. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no significant atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 54 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 42, 66, and 74 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 77. Cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 106, 115, and 84 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 97 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of significant stenosis in the right internal carotid artery. \nThere is significant improvement after right carotid endarterectomy in\ncomparison with the previous study from ___.\n\nThere is 40-59% stenosis within the left internal carotid artery. There is no\nsignificant change in comparison with the previous study from ___" + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe heterogeneous atherosclerotic plaque\ninvolving the proximal internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 45 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 535, 157, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 233 cm/sec.\nThe ICA/CCA ratio is 12.0.\nThe external carotid artery has peak systolic velocity of 92 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous atherosclerotic plaque\ninvolving the proximal internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 95, 130, and 108 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 45 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 98 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Greater than 70% stenosis of the right internal carotid artery. 50-69%\nstenosis of the left internal carotid artery." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate calcified atherosclerotic plaque in\nthe right common carotid artery and at the carotid bifurcation.\nThe peak systolic velocity in the right common carotid artery is 64.0 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 82.7, 100, and 92.0 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25.2 cm/sec.\nThe ICA/CCA ratio is 2.7.\nThe external carotid artery has peak systolic velocity of 119 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate to severe atherosclerotic plaque in\nthe left common carotid artery as noted on the prior CTA.\nThe peak systolic velocity in the left common carotid artery is 337 cm/sec\ndistally and 96.7 cm/sec proximally.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 67.6, 96.6, and 111 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 35.4 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery is completely occluded just beyond the bifurcation\nwith distal reconstitution, likely via collaterals, with reversed flow. The\nexternal carotid artery has peak systolic velocity of 87.2 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Complete occlusion of the left external carotid artery just beyond the\nbifurcation with distal reconstitution and reversed flow.\n2. Moderate to severe atherosclerotic plaque in the common carotid arteries\nbilaterally as seen on the prior CTA with elevated peak systolic velocity on\nthe left.\n3. No hemodynamically significant stenosis in the internal carotid arteries\nbilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 62 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 64, 75, and 60 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 81 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 79, 94, and 86 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 88. Cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.35 L of amber fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.35 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated small\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 1.4 L of serosanguineous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.4 L of fluid were removed." + }, + { + "input": "Right Common femoral artery: Arteriotomy was proximal to the bifurcation. \nThere is a significant amount of atherosclerosis identified the common femoral\nbifurcation into the deep femoral and superficial femoral artery. There is\nfilling of contrast into the external iliac retrograde filling into the common\niliac and filling into the internal iliac arteries.\n\nLeft common carotid artery, intracranial view: Vessel caliber smooth regular. \nThere is filling of the anterior and middle cerebral arteries as well as their\ndistal territories. The ophthalmic arteries patent as is the posterior\ncommunicating artery which has an infundibular origin. No aneurysms or AVMs\nare identified.\n\nLeft common carotid artery, cervical view: Internal and external carotid\narteries both fill from the left common carotid artery. There is a\nsignificant amount of atherosclerosis identified at the carotid bifurcation\nhowever there is no evidence of stenosis by NASCET criteria.\n\nLeft vertebral artery: Vessel caliber smooth regular. There is filling of the\nleft posterior inferior cerebellar artery with retrograde filling into the\nright vertebral artery filling the right posterior inferior cerebellar artery.\nBilateral anterior-inferior cerebellar arteries, bilateral superior cerebellar\narteries and bilateral posterior cerebral arteries fill as well as their\ndistal territories. There is filling of the right posterior communicating\nartery filling into the anterior circulation. No aneurysms or AVMs are\nidentified.\n\nRight common carotid artery, cervical view: There is filling of the internal\nand external carotid arteries from the right common carotid artery. There is\na significant amount of atherosclerosis identified at the carotid bifurcation\ninto the internal carotid artery. By NASCET criteria stenosis measured at 70\npercent internal carotid artery.\n\nRight common carotid artery, intracranial view: Vessel caliber smooth regular.\nThere is filling of the internal carotid artery filling the anterior and\nmiddle cerebral arteries and their distal territories. The ophthalmic artery\nis patent there is a fetal origin posterior communicating artery. There is a\n12 millimeter by 6.3 millimeter oblong aneurysm originating in the\ncommunicating segment ICA. This is a large thrombosed aneurysm which measures\n4.1 x 2.8 centimeters on CTA and MRI imaging. No other aneurysms or AVMs are\nidentified.", + "output": "Right common carotid artery bifurcation stenosis measuring 70 percent\n\nRight posterior communicating artery giant thrombosed aneurysm with a filling\nportion measuring 12 millimeters x 6.3 millimeters\n\nRECOMMENDATION(S):\n1. Patient will be scheduled for a right-sided carotid endarterectomy prior to\nendovascular treatment of posterior communicating artery aneurysm" + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe atherosclerotic plaque throughout the\ncommon, internal carotid artery and external carotid artery. .\nThe peak systolic velocity in the right common carotid artery is 26 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 629, 302, and 133 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 126 cm/sec.\nThe ICA/CCA ratio is 2.4.\nThe external carotid artery has peak systolic velocity of 371 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate-to-severe atherosclerotic plaque\nthroughout the common, internal carotid and external carotid artery.\nThe peak systolic velocity in the left common carotid artery is 85 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 107, 61, and 51 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 211 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate-to-severe atherosclerotic plaque involving the bilateral common\ncarotid arteries as detailed above.\n\nHigh-grade stenosis involving the right proximal internal carotid artery with\nresultant 80-99% stenosis. This is better evaluated on the available CTA of\nthe neck." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 13 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "In the plantar left foot in the area of the wound, there is a moderate amount\nof complex fluid or tissue phlegmon which is poorly organized. There is\nsubcutaneous edema.", + "output": "Deep to the wound in the plantar aspect of the left foot, there is a moderate\namount of complex fluid which is poorly organized and could represent\nphlegmonous changes. No drainable fluid collection." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 127, 132, and 90 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 0.4 cm/sec.\nThe ICA/CCA ratio is 2.3.\nThe external carotid artery has peak systolic velocity of 96 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left common carotid has mild heterogeneous atherosclerotic plaque in the\nexternal carotid has significant heterogeneous plaque.\nThe peak systolic velocity in the left common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 76, 95, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 378 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Approximately 40-50% right carotid artery stenosis with mild heterogeneous\nplaque.\n2. No evidence of hemodynamically significant left carotid artery stenosis." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 10 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\n\nThere is a mass in the upper-outer quadrant of the left breast with dense\ncalcifications, consistent with a degenerated fibroadenoma and stable in size\nand appearance since ___. There is no new dominant mass,\narchitectural distortion or suspicious grouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast, at the area\nof the palpable mass as indicated by the patient, was performed which was\nwithout any discrete suspicious solid or cystic masses.", + "output": "No mammographic or sonographic evidence of a suspicious mass in the palpated\narea, as indicated by the patient. There has been no mammographic change in\nthe appearance of either breast to indicate malignancy.\n\nRECOMMENDATION: Annual screening mammography is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere is a mass in the upper-outer quadrant of the left breast with dense\ncalcifications, consistent with a degenerated fibroadenoma and stable in size\nin appearance since ___. There is no new dominant mass, architectural\ndistortion or suspicious grouped microcalcifications.\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast, at the area\nof the palpable mass as indicated by the patient, was performed which was\nwithout any discrete suspicious solid or cystic masses.", + "output": "No mammographic or sonographic evidence of a suspicious mass in the palpated\narea, as indicated by the patient. There has been no mammographic change in\nthe appearance of either breast to indicate malignancy.\n\nRECOMMENDATION: Annual screening mammography is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "At 1 o'clock and 3 o'clock, 2- 3 cm from the nipple in the left breast, there\nis re-demonstration of two vague, avascular, hypoechoic nodules, possibly\ncomplex cysts, which have not changed in size or appearance since the previous\nultrasound. No discrete suspicious solid or cystic mass is identified.", + "output": "___ stability of small, benign-appearing nodules, possibly complex cysts,\nat 1 o'clock and 3 o'clock in the left breast.\n\nRECOMMENDATION: Left breast ultrasound followup is recommended in ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The left breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the left breast, there is a fan-shaped, subareolar density that appears to\nblend into the surrounding subcutaneous fat. No definite mass, suspicious\ncalcifications, or architectural distortion is identified.\n\nBREAST ULTRASOUND: Targeted left breast ultrasound at the site of concern as\nindicated by the patient was performed. In the retroareolar region, an\nirregular, hypoechoic triangular region is noted, without significant\nvascularity consistent with gynecomastia. No peripheral abnormalities are\nidentified.", + "output": "Findings are consistent with diffuse asymmetric left gynecomastia.\n\nRECOMMENDATION(S): Clinical follow-up is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 7.0 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis with\nremoval of 7 L of ascites." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 7 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Right lower quadrant\nFluid: 7 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 6 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 6 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6 L of fluid were removed." + }, + { + "input": "An intrauterine gestational sac is seen and a single living embryo is\nidentified with a crown rump length of 0.43 cm representing a gestational age\nof 6 weeks and 1 day. This corresponds satisfactorily with the menstrual\ndates of 6 weeks. Fetal cardiac activity with heart rate at 117 beats per\nminute demonstrated. There is a small perigestational hematoma. The uterus\nis normal. Ovaries are normal with note of a small hemorrhagic corpus luteum\nin the right ovary. No free fluid. No adnexal mass.", + "output": "1. Single live intrauterine pregnancy with size = dates.\n2. Small perigestational hematoma." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously noted focal asymmetry in the right lower outer breast persists\non compression views, a targeted ultrasound is obtained.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast was performed. In\nthe right breast at ___ o'clock, 3-4 cm from the nipple, there is a elongated,\nanechoic structure measuring 0.7 x 0.4 x 0.2 cm, without internal vascularity,\nlikely representing duct ectasia.", + "output": "Focal asymmetry in the right lower outer breast,, with corresponding duct\nectasia on targeted ultrasound at ___ o'clock. No evidence of malignancy.\n\nRECOMMENDATION(S): Annual mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up..\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe previously noted focal asymmetry in the right lower outer breast persists\non compression views, a targeted ultrasound is obtained.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast was performed. In\nthe right breast at ___ o'clock, 3-4 cm from the nipple, there is a elongated,\nanechoic structure measuring 0.7 x 0.4 x 0.2 cm, without internal vascularity,\nlikely representing duct ectasia.", + "output": "Focal asymmetry in the right lower outer breast,, with corresponding duct\nectasia on targeted ultrasound at ___ o'clock. No evidence of malignancy.\n\nRECOMMENDATION(S): Annual mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up..\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcification in either breast. There is no abnormality seen at the\ntriangle marker in the left upper-outer quadrant. There is no evidence of\ngynecomastia.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left upper outer quadrant at\nthe patient's area of concern at 1 o'clock 4 cm from the nipple demonstrates\ntwo small 5 x 3 x 4 mm hyperechoic masses without dominant vascularity,\nconsistent with lipoma. Otherwise, there is normal appearance of the breast\ntissue without an underlying suspicious solid or cystic mass.", + "output": "No specific evidence of malignancy. Two small lipoma at the patient's clinical\narea of concern.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 8\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "In the medial right breast deep to the incision, there is a 5.0 x 0.6 x 7.7 cm\npredominantly fluid collection with a few internal thin septations, but\nwithout internal vascularity. In the lateral right breast deep to the\nincision, there is a 4.2 x 1.5 x 4.7 cm anechoic fluid collection without\ninternal vascularity.", + "output": "Two fluid collections are seen in the right breast deep to the incision. One\nat the medial aspect which measures 5.0 x 0.6 x 7.7 cm and contains a small\namount of internal septations and a lateral fluid collection which measures\n4.2 x 1.5 x 4.7 cm. Again these likely reflects seromas." + }, + { + "input": "Scans of the duodenal bulb and sweep were initially performed using a high\nfrequency linear probe imaging at 15 megaHertz frequency. The duodenal wall.\nNormal apart from some small air and fluid pockets presumably at the site of\nprior biopsies. No masses or nodules could be identified.\n\nNext the entire liver was scanned for focal lesions. There is markedly\nincreased echogenicity throughout the liver consistent with severe steatosis.\n2 tiny avascular lesions were identified, a 4 mm nodule in segment 2 and a 7\nmm nodule in segment 7, both of which showed no increase in vascularity on\ncolor flow Doppler. In segment 3, hypoechoic 8 mm nodule is identified which\nshowed substantially increased vascular flow compared to the surrounding\nliver. This was considered suspicious for a metastasis and targeted for\nultrasound-guided biopsy.\n\nUsing the high-frequency linear right upper lobe, an 18 gauge Bard biopsy\nneedle was positioned in real-time and 3 targeted biopsies were obtained\nthrough the suspicious lesion in the left lateral segment. Specimens were\nprovided to pathology for frozen section.", + "output": "1. No adrenal wall lesion was identified.\n\n2. Severe hepatic steatosis with multiple small lesions, the largest of which\nin segment 3 was targeted for ultrasound-guided biopsies." + }, + { + "input": "Limited preprocedure ultrasound demonstrated the large anterior abdominal wall\nheterogeneous collection with multiple fluid pockets. The largest fluid\npocket was targeted for ultrasound-guided drainage. Successful catheter\nplacement was confirmed postprocedure with marked decrease in the size of the\ncollection post initial drainage.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nIn the area of palpable concern, in the anterior, slightly upper, mid left\nbreast, there is a subtle fatty mass, measuring approximately 2 cm in size. \nOtherwise, there is no concerning dominant mass, unexplained architectural\ndistortion, or suspicious group of microcalcifications in either breast. \nBilateral secretory and other benign calcifications are unchanged.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at the 12 o'clock\nposition, 3 cm from the nipple. Immediately deep to the skin, there is a 1.9\nx 0.6 x 1.9 cm, parallel, circumscribed, echogenic, encapsulated mass without\nsignificant posterior features. Overall, these findings are consistent with\nbenign lipoma.", + "output": "1. In the area of palpable concern, in the upper, mid left breast, there is a\n1.9 x 0.6 x 1.9 cm benign lipoma. Patient may return to age and risk\nappropriate screening mammography.\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan..\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nIn the area of palpable concern, in the anterior, slightly upper, mid left\nbreast, there is a subtle fatty mass, measuring approximately 2 cm in size. \nOtherwise, there is no concerning dominant mass, unexplained architectural\ndistortion, or suspicious group of microcalcifications in either breast. \nBilateral secretory and other benign calcifications are unchanged.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at the 12 o'clock\nposition, 3 cm from the nipple. Immediately deep to the skin, there is a 1.9\nx 0.6 x 1.9 cm, parallel, circumscribed, echogenic, encapsulated mass without\nsignificant posterior features. Overall, these findings are consistent with\nbenign lipoma.", + "output": "1. In the area of palpable concern, in the upper, mid left breast, there is a\n1.9 x 0.6 x 1.9 cm benign lipoma. Patient may return to age and risk\nappropriate screening mammography.\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan..\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. In the upper central to slightly medial\nposterior right breast is a 2.1 cm mass with an adjacent 0.9 cm mass. There\nare no associated microcalcifications. These were further evaluated with\nultrasound. Extensive bilateral vascular calcifications are seen which is\nunusual for a patient of the stated age of ___ years. Clinical correlation is\nrecommended. No clusters of suspicious microcalcification or areas of\narchitectural distortion are appreciated. There are several slightly\nprominent right axillary lymph nodes which were also further evaluated with\nultrasound.\n\nUltrasound of the right breast at 1 o'clock 15 cm from the nipple\ncorresponding to the area of concern as indicated by the patient identifies a\nheterogeneous mass measuring 2.0 x 0.8 x 1.7 cm with a contiguous 0.8 x 0.7 x\n0.3 cm. Both masses appear to have an echogenic halo. Findings are\nconcerning for malignancy although benign etiology such is hematoma should\nalso be considered. Biopsy of these findings seems the most reasonable\napproach at this time.\n\nUltrasound of the right axilla demonstrates several benign appearing lymph\nnodes although there is a borderline lymph node measuring 1.6 x 0.6 x 1.0 cm\nwhich has a 0.3 cm cortex. Although this may be reactive, other etiologies\nshould be considered.", + "output": "Two indeterminate masses in the right breast for which ultrasound-guided core\nbiopsy should be considered at this time. Borderline right axillary lymph\nnode, the management of which will depend on the biopsy results of the right\nbreast mass.\n\nRECOMMENDATION(S): Right breast ultrasound-guided core biopsy which was\nundertaken following the diagnostic evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The patient underwent right breast ultrasound-guided core biopsy which\nwas performed following completion of the diagnostic evaluation after\ndiscussion with Dr. ___ inpatient care team given the elevated\nINR.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "The recently seen 2.3 cm mass in the right breast at 1 o'clock is\nre-demonstrated and targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D..\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 16-gauge achieve needle. Next, a percutaneous\nHydroMark coil was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated small amount\nof loculated ascites with extensive septations in the right upper quadrant. A\nsuitable target in the deepest pocket in the right upper quadrant was selected\nfor paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 20cc spinal needle was advanced into the largest fluid pocket in the right\nupper quadrant under direct sonographic guidance and 40 cc of clear,\nstraw-colored fluid were removed. Fluid samples were submitted to the\nlaboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 40 cc of clear straw-colored fluid was removed and sent for lab testing as\nrequested." + }, + { + "input": "Right breast ultrasound: Targeted ultrasound the right upper outer breast was\nperformed. The right breast was scanned with the patient sitting in a\nwheelchair with the help of two patient aids. The area of from ___ o'clock\nwas scanned and no discrete solid or cystic mass was seen on this limited\nultrasound.", + "output": "Unremarkable targeted right breast ultrasound.\n\nRECOMMENDATION: Final disposition of palpable area should be based on\nclinical evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nIn the lateral breast areas of pain, there are no mammographic abnormalities. \nSpecifically, there are no dominant masses, architectural distortions, or\nsuspicious grouped microcalcifications in either breast. A biopsy marker is\nvisualized in the left breast.\n\nBREAST ULTRASOUND: Targeted breast ultrasound was performed in the area of\npain. In the right breast at 12 and 1 o'clock, 14 cm from nipple, no discrete\nsolid or cystic suspicious masses were identified. In the left breast at 3\no'clock, 13 cm from nipple, no discrete suspicious solid or cystic masses were\nidentified.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Clinical follow-up is recommended for the bilateral breast\npain. Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nIn the lateral breast areas of pain, there are no mammographic abnormalities. \nSpecifically, there are no dominant masses, architectural distortions, or\nsuspicious grouped microcalcifications in either breast. A biopsy marker is\nvisualized in the left breast.\n\nBREAST ULTRASOUND: Targeted breast ultrasound was performed in the area of\npain. In the right breast at 12 and 1 o'clock, 14 cm from nipple, no discrete\nsolid or cystic suspicious masses were identified. In the left breast at 3\no'clock, 13 cm from nipple, no discrete suspicious solid or cystic masses were\nidentified.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Clinical follow-up is recommended for the bilateral breast\npain. Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density. There\nare stable right post surgial changes. Grouped heterogeneous calcifications in\nthe upper central left breast warrant stereotactic core biopsy at this time.\nNo suspicious mass is seen in either breast. A biopsy marker is again\ndemonstrated in the central slightly upper left breast at mid depth.\n\nUltrasound was performed in area of pain as denoted by the patient in the\nright breast from 10 o'clock to 2 o'clock 1-8 cm from the nipple. There were\nmultiple mildly dilated branching ducts and a few scattered simple cysts, the\nlargest measuring 0.3 cm at 1 o'clock 4-5 cm from the nipple. No solid\nsuspicious mass was seen. Further management of the patient's symptoms at this\ntime should be based on the clinical assessment.", + "output": "1. Indeterminate left breast grouped calcifications for which stereotactic\ncore biopsy is recommended at this time.\n2. Ductal ectasia and scattered fibrocystic changes in the area of pain as\nindicated by the patient. Further management of the patient's symptoms at\nthis time should be based on the clinical assessment.\n\nRECOMMENDATION(S):\n1. Stereotactic guided core biopsy of left breast calcifications on the prone\nor upright system.\n2. Clinical follow up for right breast pain.\n\nNOTIFICATION: Via an interpreter, findings and recommendation for biopsy were\nreviewed with the patient who agrees with this plan. She was given information\nto schedule her biopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 17:11 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4B Suspicious - moderate suspicion for malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density. There\nare stable right post surgial changes. Grouped heterogeneous calcifications in\nthe upper central left breast warrant stereotactic core biopsy at this time.\nNo suspicious mass is seen in either breast. A biopsy marker is again\ndemonstrated in the central slightly upper left breast at mid depth.\n\nUltrasound was performed in area of pain as denoted by the patient in the\nright breast from 10 o'clock to 2 o'clock 1-8 cm from the nipple. There were\nmultiple mildly dilated branching ducts and a few scattered simple cysts, the\nlargest measuring 0.3 cm at 1 o'clock 4-5 cm from the nipple. No solid\nsuspicious mass was seen. Further management of the patient's symptoms at this\ntime should be based on the clinical assessment.", + "output": "1. Indeterminate left breast grouped calcifications for which stereotactic\ncore biopsy is recommended at this time.\n2. Ductal ectasia and scattered fibrocystic changes in the area of pain as\nindicated by the patient. Further management of the patient's symptoms at\nthis time should be based on the clinical assessment.\n\nRECOMMENDATION(S):\n1. Stereotactic guided core biopsy of left breast calcifications on the prone\nor upright system.\n2. Clinical follow up for right breast pain.\n\nNOTIFICATION: Via an interpreter, findings and recommendation for biopsy were\nreviewed with the patient who agrees with this plan. She was given information\nto schedule her biopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 17:11 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4B Suspicious - moderate suspicion for malignancy." + }, + { + "input": "Focus ultrasounds of the inner left breast was performed. In the left breast\nat 11 o'clock located 3 cm from the nipple there is a hypoechoic mass with\ninternal septations and posterior acoustic enhancement consistent with a\ncluster of cysts. This cluster of cysts measures 0.6 x 0.3 x 0.7 cm.\nAt the time of sonographic evaluation the patient indicated focal pain in the\nouter left breast, therefore a focused ultrasounds of the left breast at 4\no'clock located 13 cm from the nipple was performed in the area of pain as\nindicated by the patient. No sonographic abnormality is identified.", + "output": "Left breast cluster cysts benign.\n\nLeft breast calcifications are suspicious.\n\nRECOMMENDATION(S): Stereotactic core biopsy of calcifications in the left\nbreast as indicated from the diagnostic mammography report ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy using the hospital provided ___ interpreter.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.1 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.1 L of fluid were removed." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 62, 73, and 74 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 24\ncm/sec.\nThe ICA/CCA ratio is 0.99.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has homogeneous, occlusive atherosclerotic\nplaque.\nThere is no flow identified in the common or proximal external or internal\ncarotid arteries.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA is occluded." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 83, 85, and 87 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has severe atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 26 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 0, 0, and 0 cm/sec, respectively.\nThe external carotid artery has peak systolic velocity of 184 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "The left ICA is occluded.\nRight ICA ___ stenosis.\nAntegrade vertebral flow." + }, + { + "input": "Limited preprocedure ultrasound of the neck demonstrate multiple bilateral\nenlarged lymph nodes. No drainable fluid collections were seen. A\nconglomerate of lymph nodes with increased vascularity on the left (level 1)\nwas selected for biopsy. A small superficial hematoma was seen at the biopsy\nsite immediately following the procedure.", + "output": "1. Successful ultrasound-guided core-biopsy of a conglomeration of markedly\nenlarged left neck nodes. A total of five core biopsy specimens were obtained\nfor histopathology, flow cytometry and cytogenetics per lymphoma protocol.\n2. No drainable fluid collections.\n3. Small superficial post-biopsy hematoma." + }, + { + "input": "RIGHT:\nThere is now atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 141 cm/s / 21 cm/s\nCCA Distal: 102 cm/s / 20 cm/s\nICA ___: 55 cm/s / 16 cm/s\nICA Mid: 60 cm/s / 19 cm/s\nICA Distal: 66 cm/s/ 24\nECA: 137 cm/s\nVertebral: 54 cm/s\n\nICA/CCA Ratio: 0.7\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 129 cm/s / 21 cm/s\nCCA Distal: 94 cm/s / 23 cm/s\nICA ___: 73 cm/s / 25 cm/s\nICA Mid: 73 cm/s / 20 cm/s\nICA Distal: 95 cm/s / 28 cm/s\nECA: 87 cm/s\nVertebral: 80 cm/s\n\nICA/CCA Ratio: 1.0\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere are multiple bilateral round and oval circumscribed masses, likely\nrepresenting cysts. There is a circumscribed oval mass in the lower inner\nquadrant of the right breast measuring 10 mm for which ultrasound evaluation\nwas performed. There is no definitive suspicious mass or suspicious group of\nmicrocalcifications in the 12 o'clock position of the right breast in the area\npalpable concern as indicated by the patient's physician. There is an\nasymmetry in the lower-inner quadrant of the left breast, which may represent\nmultiple cysts or an area of fibrocystic tissue which is pliable and\nspot-compression views.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast in the area of\nmammographic concern at 7 o'clock, 8 cm from the nipple demonstrates a simple\ncyst measuring 8 mm by 4 mm x 10 mm. This does not correspond to the size of\nthe mammographic mass. At 8 o'clock 5 cm from the nipple there is a patch of\nfibrocystic tissue measuring 27 mm by 6 mm x 14 mm. This is felt to\ncorrespond to the asymmetry seen mammographically in the lower-inner quadrant\nof the left breast.\n\nTargeted ultrasound of the right breast in the lower inner quadrant\ndemonstrates a cluster cysts measuring 11 mm by 4 mm x 9 mm corresponding to\nthe mammographic mass at 4 o'clock, 3 cm from the nipple. In the area\npalpable concern as indicated by the patient's physician ___ 12 o'clock 4 cm\nfrom the nipple there is a simple cyst measuring 8 mm x 5 mm by 8 mm. There\nis no suspicious mass or suspicious sonographic finding in this area.", + "output": "Bilateral cysts as described.\nArea of probable fibrocystic change corresponding to an asymmetry seen in the\nlower-inner quadrant of left breast. Six-month follow-up is recommended.\n\nRECOMMENDATION(S): Left diagnostic mammogram and ultrasound in 6 months\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere are multiple bilateral round and oval circumscribed masses, likely\nrepresenting cysts. There is a circumscribed oval mass in the lower inner\nquadrant of the right breast measuring 10 mm for which ultrasound evaluation\nwas performed. There is no definitive suspicious mass or suspicious group of\nmicrocalcifications in the 12 o'clock position of the right breast in the area\npalpable concern as indicated by the patient's physician. There is an\nasymmetry in the lower-inner quadrant of the left breast, which may represent\nmultiple cysts or an area of fibrocystic tissue which is pliable and\nspot-compression views.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast in the area of\nmammographic concern at 7 o'clock, 8 cm from the nipple demonstrates a simple\ncyst measuring 8 mm by 4 mm x 10 mm. This does not correspond to the size of\nthe mammographic mass. At 8 o'clock 5 cm from the nipple there is a patch of\nfibrocystic tissue measuring 27 mm by 6 mm x 14 mm. This is felt to\ncorrespond to the asymmetry seen mammographically in the lower-inner quadrant\nof the left breast.\n\nTargeted ultrasound of the right breast in the lower inner quadrant\ndemonstrates a cluster cysts measuring 11 mm by 4 mm x 9 mm corresponding to\nthe mammographic mass at 4 o'clock, 3 cm from the nipple. In the area\npalpable concern as indicated by the patient's physician ___ 12 o'clock 4 cm\nfrom the nipple there is a simple cyst measuring 8 mm x 5 mm by 8 mm. There\nis no suspicious mass or suspicious sonographic finding in this area.", + "output": "Bilateral cysts as described.\nArea of probable fibrocystic change corresponding to an asymmetry seen in the\nlower-inner quadrant of left breast. Six-month follow-up is recommended.\n\nRECOMMENDATION(S): Left diagnostic mammogram and ultrasound in 6 months\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n The asymmetry in the lower inner left breast is far less conspicuous than on\nthe prior examinations. It is only clearly identified on the left MLO spot\ncompression view performed today. On 3D imaging this area has the appearance\nof breast tissue.\n\nStable benign-appearing calcifications within the right and left breast. No\nadditional abnormalities are identified in either breast.\n\nBREAST ULTRASOUND: The previously identified area in the left breast at 8\no'clock 5 cm from the nipple could not be identified. Normal breast tissue\nwas seen throughout the lower inner left breast..", + "output": "1. Stable asymmetry lower inner quadrant left breast without ultrasound\ncorrelate on today's study. This is felt most likely to represent benign\ndense breast tissue.\n\n2. No abnormality is identified throughout the remaining aspect of the left\nor right breast.\n\nRECOMMENDATION(S): Left breast asymmetry is far less conspicuous and appears\nas normal breast tissue. Continued followup in one year is recommended to\nconfirm stability and benignity.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy with the aid of a ___ interpreter over the phone.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Large ill-defined hepatic lesion is identified with multiple necrotic\nhypoechoic areas. Biopsies will be attempted at the periphery of the lesion.", + "output": "Successful targeted ultrasound-guided biopsy of large hepatic mass." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nMarker clips in both breast the site of prior benign biopsies are unchanged. \nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nLEFT BREAST ULTRASOUND:\n\nTargeted ultrasound was performed. Selected images were obtained. In the 1\no'clock 2 cm from the nipple there are 2 subjacent ovoid hypoechoic masses. \nThese measure 0.4 x 0.5 x 0.5 cm and 0.4 x 0.4 x 0.4 cm each respectively and\ndemonstrates no internal vascularity or posterior features. Both are\nsonographically stable in appearance.", + "output": "___ years stability of 2 probable benign masses in the left breast. No\nmammographic evidence of malignancy.\n\nRECOMMENDATION: A further followup in ___ year with a left breast ultrasound\nand bilateral annual mammography is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThere are biopsy marking clips noted in both breasts. There is a benign\nintramammary node on the right. A few scattered benign calcifications are\nseen in the right breast. The left nipple is flattened but unchanged from\nprior exams. There are no developing masses or areas of architectural\ndistortion. No suspicious calcifications are seen.\nBREAST ULTRASOUND: Targeted left breast ultrasound was performed and shows 2\nstable hypoechoic masses along the 1 o'clock axis and 2 cm from the nipple. 1\nmeasures 0.4 x 0.6 cm in the second measures 0.4 x 0.5 cm. There is no\nassociated vascularity or shadowing.", + "output": "No mammographic change to indicate malignancy. ___ year stability for 2 masses,\nidentified by ultrasound in the upper-outer left breast. Given multi year\nstability, these are felt to be benign and do not warrant any further imaging\nfollowup.\n\nRECOMMENDATION(S): Routine screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4.6 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4.6 L of fluid were removed and sent for requested analysis." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThere is an oval circumscribed mass in the right upper central breast without\nany associated calcifications or distortion. This fills in the ultrasound\ncorresponds to a probable cyst.\n\nRIGHT BREAST ULTRASOUND:\n\nTargeted ultrasound of the right upper lateral quadrant was performed. In the\n1 o'clock 3 cm from the nipple, there is an oval circumscribed that a\nhypoechoic mass which measures 0.8 x 0.2 x 0.7 cm and demonstrates no internal\nvascularity or posterior features. This likely represents a cyst and\ncorresponds to the mass seen on the mammogram.", + "output": "Probable cyst in the 1 o'clock seen on ultrasound corresponding to the mass on\nthe mammogram.\n\nRECOMMENDATION: Due to the interval development in this postmenopausal woman,\nthis cyst aspiration is recommended to confirm diagnosis.\n\nNOTIFICATION: Findings were discussed in detail with the patient had a cyst\naspiration was performed subsequent to the diagnostic evaluation.\n\n\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy.\n\n\n." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThere is an oval circumscribed mass in the right upper central breast without\nany associated calcifications or distortion. This fills in the ultrasound\ncorresponds to a probable cyst.\n\nRIGHT BREAST ULTRASOUND:\n\nTargeted ultrasound of the right upper lateral quadrant was performed. In the\n1 o'clock 3 cm from the nipple, there is an oval circumscribed that a\nhypoechoic mass which measures 0.8 x 0.2 x 0.7 cm and demonstrates no internal\nvascularity or posterior features. This likely represents a cyst and\ncorresponds to the mass seen on the mammogram.", + "output": "Probable cyst in the 1 o'clock seen on ultrasound corresponding to the mass on\nthe mammogram.\n\nRECOMMENDATION: Due to the interval development in this postmenopausal woman,\nthis cyst aspiration is recommended to confirm diagnosis.\n\nNOTIFICATION: Findings were discussed in detail with the patient had a cyst\naspiration was performed subsequent to the diagnostic evaluation.\n\n\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy.\n\n\n." + }, + { + "input": "Preprocedure ultrasound redemonstrates an ovoid anechoic mass in the 1 o'clock\nto 2 4 cm from the nipple with good through transmission and no internal\nvascularity.\n\nPROCEDURE: The procedure, risks and benefits explained to the patient and\nwritten informed consent was obtained. A pre procedure time-out was performed\nusing the patient identifiers. Laterality was confirmed and all allergies and\nmedications were reviewed.\nUsing standard aseptic technique and 1% lidocaine for local anesthesia, an 19\ngauge needle was advanced into the cyst and 0.2 cc of fluid was aspirated\nunder continuous ultrasound guidance. The cyst fluid appears normal and hands\nwas not sent for cytology. The patient tolerated the procedure well without\nany immediate complications. Detailed post procedure instructions were\nprovided.\nA post procedure two-view mammogram demonstrates a small hematoma at the site\nof aspiration and no definite residual mass is identified.", + "output": "Technically successful ultrasound-guided aspiration of right breast cyst." + }, + { + "input": "Preprocedure ultrasound redemonstrates an ovoid anechoic mass in the 1 o'clock\nto 2 4 cm from the nipple with good through transmission and no internal\nvascularity.\n\nPROCEDURE: The procedure, risks and benefits explained to the patient and\nwritten informed consent was obtained. A pre procedure time-out was performed\nusing the patient identifiers. Laterality was confirmed and all allergies and\nmedications were reviewed.\nUsing standard aseptic technique and 1% lidocaine for local anesthesia, an 19\ngauge needle was advanced into the cyst and 0.2 cc of fluid was aspirated\nunder continuous ultrasound guidance. The cyst fluid appears normal and hands\nwas not sent for cytology. The patient tolerated the procedure well without\nany immediate complications. Detailed post procedure instructions were\nprovided.\nA post procedure two-view mammogram demonstrates a small hematoma at the site\nof aspiration and no definite residual mass is identified.", + "output": "Technically successful ultrasound-guided aspiration of right breast cyst." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nAdditional views confirm a 6-7 mm spiculated mass within the upper and\nslightly outer left breast mid to posterior depth. This was further evaluated\nwith ultrasound. There is no additional suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound 1 o'clock left breast 9 cm from the\nnipple performed covering area of concern on mammogram which demonstrates a\n0.7 x 0.4 x 0.4 cm irregular hypoechoic mass with echogenic halo, posterior\nshadowing, and internal color flow. This corresponds to the mass seen on\nmammogram and is highly suggestive of malignancy.", + "output": "0.7 cm mass 1 o'clock left breast 9 cm from the nipple highly suggestive of\nmalignancy. Ultrasound-guided biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy left breast mass.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She will be scheduled for same day biopsy. \nResults recommendations were also communicated to the ordering provider by\nemail at 3:08 p.m. on ___.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Preprocedure imaging again demonstrates a mass 12 o'clock left breast 9 cm\nfrom the nipple highly suggest malignancy. This was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Preprocedure imaging again demonstrates a mass 12 o'clock left breast 9 cm\nfrom the nipple highly suggest malignancy. This was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate of\ncomplex, multi-septated ascites. A suitable target in the deepest pocket in\nthe right lower quadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 0.2 L of mixed hemorrhagic/serosanguineous fluid was\nremoved. Postprocedure ultrasound demonstrated residual complex,\nmulti-septated ascites, which could not be drained further.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis. Aspirated fluid was mixed hemorrhagic/serosanguineous,\nappearing multi-septated on ultrasound, compatible with hemorrhagic\nascites/hemoperitoneum.\n2. 0.2 L of fluid were removed and sent for analysis." + }, + { + "input": "Limited preprocedure ultrasound of the lower abdomen shows a moderate amount\nof ascites with diffuse internal echoes. This was aspirated to completion,\nand a drainage catheter was left in place given the purulent nature of the\nfluid.", + "output": "Successful US-guided paracentesis and placement of an ___ pigtail\ncatheter into the right lower quadrant. Samples were sent for chemistry,\nhematology, cytology, and microbiology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque in the proximal\nleft internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 98 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 92, 99, and 110 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 38 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 101 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque within the\nproximal internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 115 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 78, 96, and 82 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 0.83.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Bilateral mild heterogeneous atherosclerotic disease of the proximal\ninternal carotid arteries, left greater than right.\n2. No hemodynamically significant stenosis of the carotid arteries\nbilaterally (less than 40%)." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: There is no sonographic abnormality to correspond with\narea of pain described by the patient in the upper inner left breast. No other\nabnormality seen.", + "output": "No evidence of malignancy\n\nRECOMMENDATION: Annual screening mammogram is recommended\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "At 12 o'clock, 1 cm the nipple is a 1.1 x 0.6 x 1 cm hypoechoic ill-defined,\navascular mass without posterior features which is referred to as lesion # 1.\n\nAt 12 o'clock 6 cm from the nipple is a 0.7 x 0.5 x 0.7 cm hypoechoic\nill-defined avascular mass without posterior features which is referred to as\nlesion # 2.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ MD ___ NP. The procedure\nwas supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to lesion #1 at 12\no'clock, 1 cm from the nipple and 5 cores were obtained using a 14-gauge Bard\nspring-loaded biopsy device. The lesion became less conspicuous on subsequent\ncores. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to lesion #2 at 12 o'clock, 6 cm from the\nnipple and 4 cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. The lesion became less conspicuous on subsequent cores. Next, a\npercutaneous HydroMark coil was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology labeled as left breast mass 12 o'clock 1 cm from\nthe nipple and 12 o'clock 6 cm from the nipple.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacements.", + "output": "Technically successful US-guided core biopsy of two left breast lesions which\nbecame less conspicuous on subsequent cores. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "At 12 o'clock, 1 cm the nipple is a 1.1 x 0.6 x 1 cm hypoechoic ill-defined,\navascular mass without posterior features which is referred to as lesion # 1.\n\nAt 12 o'clock 6 cm from the nipple is a 0.7 x 0.5 x 0.7 cm hypoechoic\nill-defined avascular mass without posterior features which is referred to as\nlesion # 2.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ MD ___ NP. The procedure\nwas supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to lesion #1 at 12\no'clock, 1 cm from the nipple and 5 cores were obtained using a 14-gauge Bard\nspring-loaded biopsy device. The lesion became less conspicuous on subsequent\ncores. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to lesion #2 at 12 o'clock, 6 cm from the\nnipple and 4 cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. The lesion became less conspicuous on subsequent cores. Next, a\npercutaneous HydroMark coil was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology labeled as left breast mass 12 o'clock 1 cm from\nthe nipple and 12 o'clock 6 cm from the nipple.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacements.", + "output": "Technically successful US-guided core biopsy of two left breast lesions which\nbecame less conspicuous on subsequent cores. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.6 L of reddish yellow fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Therapeutic and diagnostic paracentesis\n2. 2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.6 L of clear orange fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.6 L of fluid were removed." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere are 2 stable biopsy clips in the left breast as well as multiple\nbenign-appearing calcifications. There is no suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcification. \nParenchymal pattern is stable.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the left breast area\nof clinical concern as directed by the patient. There is superficial bruising\nin the left breast area of clinical concern involving the skin. Underlying\nthis, at the 8 o'clock position 7 cm from the nipple, there is a 7 x 6 x 4 mm\noval mass with circumscribed margins and mixed internal echogenicity,\npredominantly hyperechoic, with appearance suggestive of hematoma.", + "output": "Sonographic left breast mass is probably benign, likely evolving hematoma, in\nthe setting of recent fall with skin bruising. No specific mammographic\nevidence of malignancy in the left breast.\n\nRECOMMENDATION(S): Short-term interval left breast ultrasound follow-up in 3\nmonths.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasounds performed at 8 o'clock 7 cm from nipple in the area of\nconcern on the prior study. The previously identified heterogeneous mass is\nno longer identified consistent with resolved hematoma. There is no\nsuspicious solid or cystic mass in this area.", + "output": "Interval resolution of left breast mass consistent with resolved hematoma. No\nfurther imaging follow-up is required.\n\nRECOMMENDATION(S): Annual screening mammography for which the patient is due\nin ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: There are grouped fine linear branching calcifications in a\nductal distribution involving an area of approximately 1.7 x 2.7 x 1.7 cm\nwithin the central, slightly upper right breast at the lumpectomy site. There\nis no associated mass. A second group of punctate calcifications measuring\napproximately 4 mm located anterior and slightly medial to the larger group is\nunchanged from prior studies.\n\nLeft breast: An oval asymmetry in the slightly outer upper left breast\nmeasuring 8 mm is more prominent compared with prior studies. A second\nasymmetry measuring approximately 10 mm is located within the subareolar left\nbreast, best appreciated on the CC view. There are no new suspicious\ncalcifications in the left breast.\n\nBenign scattered calcifications are seen bilaterally.\n\nBREAST ULTRASOUND:\n\nRight Breast: Targeted ultrasound in the area of suspicious calcifications\nrevealed no sonographic correlate for the mammographic findings.\n\nLeft Breast: In the left breast at 12 o'clock, 1 cm from the nipple there is\na 1.1 x 0.6 x 0.8 cm avascular hypoechoic mass with irregular margins, which\ncorresponds to the retroareolar asymmetry seen on the mammogram. In the left\nbreast at 12 o'clock, 6 cm from the nipple there is a lobulated, parallel,\nwell-circumscribed, avascular, hypoechoic mass measuring 0.6 x 0.5 x 0.3 cm,\ncorresponding to the upper left breast asymmetry.\n\nNo abnormal lymph nodes are identified in either axilla.", + "output": "1. A group of fine linear branching calcifications in the right upper central\nbreast lumpectomy bed is highly suspicious for recurrent malignancy and\nstereotactic core biopsy is recommended.\n2. Left breast retroareolar asymmetry corresponds to a hypoechoic mass at 12\no'clock, 1 cm from the nipple for which ultrasound-guided core needle biopsy\nis recommended.\n3. Increasing prominence of central left upper breast asymmetry corresponding\nto a hypoechoic mass on ultrasound at 12 o'clock, 6 cm from the nipple for\nwhich ultrasound-guided core needle biopsy is recommended.\n\nRECOMMENDATION(S):\n1. Stereotactic core biopsy of the right breast grouped calcifications.\n2. Ultrasound-guided core needle biopsy of the hypoechoic mass in the\nretroareolar left breast at 12 o'clock, 1 cm from the nipple.\n3. Ultrasound-guided core needle biopsy of the hypoechoic mass at 12 o'clock,\n6 cm from the nipple.\n\nNOTIFICATION: Findings and recommendations for biopsies were reviewed with\nthe patient who agrees with this plan. She was given information to schedule\nher biopsy.\n\nThe findings and recommendations for biopsies were emailed to the referring\nprovider as well to facilitate scheduling of the biopsies after the active\ninfectious processes have resolved.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast: There are grouped fine linear branching calcifications in a\nductal distribution involving an area of approximately 1.7 x 2.7 x 1.7 cm\nwithin the central, slightly upper right breast at the lumpectomy site. There\nis no associated mass. A second group of punctate calcifications measuring\napproximately 4 mm located anterior and slightly medial to the larger group is\nunchanged from prior studies.\n\nLeft breast: An oval asymmetry in the slightly outer upper left breast\nmeasuring 8 mm is more prominent compared with prior studies. A second\nasymmetry measuring approximately 10 mm is located within the subareolar left\nbreast, best appreciated on the CC view. There are no new suspicious\ncalcifications in the left breast.\n\nBenign scattered calcifications are seen bilaterally.\n\nBREAST ULTRASOUND:\n\nRight Breast: Targeted ultrasound in the area of suspicious calcifications\nrevealed no sonographic correlate for the mammographic findings.\n\nLeft Breast: In the left breast at 12 o'clock, 1 cm from the nipple there is\na 1.1 x 0.6 x 0.8 cm avascular hypoechoic mass with irregular margins, which\ncorresponds to the retroareolar asymmetry seen on the mammogram. In the left\nbreast at 12 o'clock, 6 cm from the nipple there is a lobulated, parallel,\nwell-circumscribed, avascular, hypoechoic mass measuring 0.6 x 0.5 x 0.3 cm,\ncorresponding to the upper left breast asymmetry.\n\nNo abnormal lymph nodes are identified in either axilla.", + "output": "1. A group of fine linear branching calcifications in the right upper central\nbreast lumpectomy bed is highly suspicious for recurrent malignancy and\nstereotactic core biopsy is recommended.\n2. Left breast retroareolar asymmetry corresponds to a hypoechoic mass at 12\no'clock, 1 cm from the nipple for which ultrasound-guided core needle biopsy\nis recommended.\n3. Increasing prominence of central left upper breast asymmetry corresponding\nto a hypoechoic mass on ultrasound at 12 o'clock, 6 cm from the nipple for\nwhich ultrasound-guided core needle biopsy is recommended.\n\nRECOMMENDATION(S):\n1. Stereotactic core biopsy of the right breast grouped calcifications.\n2. Ultrasound-guided core needle biopsy of the hypoechoic mass in the\nretroareolar left breast at 12 o'clock, 1 cm from the nipple.\n3. Ultrasound-guided core needle biopsy of the hypoechoic mass at 12 o'clock,\n6 cm from the nipple.\n\nNOTIFICATION: Findings and recommendations for biopsies were reviewed with\nthe patient who agrees with this plan. She was given information to schedule\nher biopsy.\n\nThe findings and recommendations for biopsies were emailed to the referring\nprovider as well to facilitate scheduling of the biopsies after the active\ninfectious processes have resolved.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in segment 6. A suitable\napproach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a single 18-gauge core biopsy sample was\nobtained. The sample was provided to the on-site cytologist who indicated an\nadequate sample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n0.5 mg Versed and 25mcg fentanyl throughout the total intra-service time of\n23minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 1, with specimen provided to\nthe cytologist." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast. Vascular calcifications are noted.\n\nBREAST ULTRASOUND: Targeted ultrasound exam of the left retroareolar area was\nperformed. No discrete cystic or solid mass is identified.", + "output": "No mammographic or sonographic correlate to patient's left nipple pain and\ndischarge.\nNo specific mammographic evidence of malignancy.\n\nRECOMMENDATION: 1. Further management of patient's left nipple pain/\ndischarge should be based on clinical assessment at this time.\n2. Annual screening mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Successful FNA of left axillary lymph node with 2 passes and 2 x 18g core\nneedle biopsy.", + "output": "Successful fine-needle aspiration and core needle biopsy of left axillary\nlymph node. Pathology is pending." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast. Vascular calcifications are noted.\n\nBREAST ULTRASOUND: Targeted ultrasound exam of the left retroareolar area was\nperformed. No discrete cystic or solid mass is identified.", + "output": "No mammographic or sonographic correlate to patient's left nipple pain and\ndischarge.\nNo specific mammographic evidence of malignancy.\n\nRECOMMENDATION: 1. Further management of patient's left nipple pain/\ndischarge should be based on clinical assessment at this time.\n2. Annual screening mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 109 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 61, 58, and 70 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.64.\nThe external carotid artery has peak systolic velocity of 97 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 47, 63, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 81 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous plaque within both internal carotid arteries with less than\n40% stenosis of each internal carotid artery." + }, + { + "input": "BREAST ULTRASOUND: Targeted ultrasound of the left breast at 5 o'clock 10 cm\nfrom the nipple, at the site of the previously seen mammographic abnormality,\ndemonstrates a group of clustered microcysts measuring 0.7 x 0.5 x 0.5 cm. No\nadditional findings are identified.", + "output": "A group of clustered microcysts corresponds to the previously seen\nmammographic left breast mass. A follow-up in 6 months is recommended.\n\nRECOMMENDATION(S): Sonographic and mammographic follow-up in 6 months is\nrecommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThe previously noted mass in the lower outer right breast is re-demonstrated. \nIt measures 0.8 cm and is little changed from the prior examination 7 months\nago. This will be further evaluated with ultrasound.\n\nLEFT BREAST ULTRASOUND: At 5 o'clock 10 cm from the nipple there is\nre-demonstration of a 0.2 x 0.5 by 0.4 cm group of microcysts. This is\nunchanged from the prior examination.", + "output": "Six-month stability of right breast mass likely representing a group of\nmicrocysts.\n\nRECOMMENDATION(S): Continued followup in 6 months is recommended at which\ntime the patient be due for an annual bilateral mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast. Previously noted mass in the lower\nright breast is not clearly identified on the current examination.\n\nLEFT BREAST ULTRASOUND: At 5 o'clock 10 cm from the nipple there is\nre-demonstration of a 0.6 x 0.5 x 0.5 cm mass that has the appearance of\ngrouped microcysts.", + "output": "One year stability of a probably benign right breast mass seen on ultrasound. \nThe presumed mammographic correlate is less well appreciated on the current\nmammogram.\n\nRECOMMENDATION(S): One year follow-up mammogram and ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "1. Pre-procedure imaging demonstrated a moderate-sized pocket of fluid in the\nleft pleural space corresponding to the pocket seen on the most recent CT.\n2. 8 ___ pigtail catheter placed in the left pleural effusion. \nApproximately 500 cc of serosanguineous fluid was drained and a sample sent\nfor microbiology evaluation.\n3. No immediate postprocedural complications.", + "output": "Successful US-guided placement of ___ pigtail catheter into the left\npleural effusion. Samples was sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 36 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 33, 40, and 33 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 51 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 39 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 29, 42, and 48 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 46 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nDeep to the bb marker, there is a nodule in the right upper outer breast\nmeasuring 8 mm. Stable intramammary lymph nodes are again demonstrated in the\nupper-outer left breast. No suspicious microcalcifications are identified. \nThe left breast is unchanged from ___.\n\nBREAST ULTRASOUND: Evaluation of the area palpable concern was performed. At\n9 o'clock in the right breast, 5 cm from the nipple there is an irregular\ntaller than wide hypervascular hypoechoic mass measuring 5 mm x 9 mm x6 mm. \nThis corresponds to the mammographic nodule. No posterior shadowing is\nidentified.\nEvaluation of the right axilla was performed. In the inferior portion of the\nright axilla, a lymph node is identified with an abnormal thickened cortex. \nMeasuring 4 mm in thickness.", + "output": "Suspicious right breast mass corresponding to the palpable finding. Right\naxillary lymph node with thickened cortex.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy is recommended for\nthe palpable mass. FNA of the right axillary lymph node can also be\nperformed.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Targeted imaging of the right breast at 9 o'clock 5 cm from nipple shows a 6 x\n8 x 6 mm hypoechoic mass, taller than wide which was the target for biopsy. \nTargeted imaging of the right axilla showed multiple benign-appearing lymph\nnodes. Targeted imaging in the right lower axilla also re-identified an area\nwhere an axillary lymph node with a thickened cortex was thought to be. This\narea appears to be intramuscular and was felt to reflect musculature\nheterogeneity rather than an abnormal lymph node. Based upon this finding,\nafter discussion with the patient, FNA was not performed today.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ and ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending. Right axillary fine-needle aspiration was not performed\nas the area of concern was thought to reflect musculature heterogeneity rather\nthan a lymph node.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted imaging of the right breast at 9 o'clock 5 cm from nipple shows a 6 x\n8 x 6 mm hypoechoic mass, taller than wide which was the target for biopsy. \nTargeted imaging of the right axilla showed multiple benign-appearing lymph\nnodes. Targeted imaging in the right lower axilla also re-identified an area\nwhere an axillary lymph node with a thickened cortex was thought to be. This\narea appears to be intramuscular and was felt to reflect musculature\nheterogeneity rather than an abnormal lymph node. Based upon this finding,\nafter discussion with the patient, FNA was not performed today.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ and ___, M.D.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending. Right axillary fine-needle aspiration was not performed\nas the area of concern was thought to reflect musculature heterogeneity rather\nthan a lymph node.\n\nThe patient expects to hear the pathology results from Dr. ___ in\n___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is a 2.8 x 1.8 cm poorly defined area of increased tissue density/focal\nasymmetry in the right outer inferior breast at middle-posterior depth. This\ncorresponds to the ultrasound finding seen at this location at 8 o'clock. \nOtherwise, the right breast is remarkable for numerous oil cysts many of which\nare calcified including the largest in the outer inferior quadrant at anterior\ndepth measuring 1.7 x 1.1 cm. The right breast is without suspicious\ncalcifications.\n\nThe left breast is without suspicious dominant mass, architectural distortion\nor suspicious grouped calcifications. Scattered benign calcifications are\nseen in the left breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at 8 o'clock\n10 cm from the nipple demonstrates a hyperechoic poorly defined mass/area of\nparenchyma measuring 2.8 x 1.6 x 2.4 cm. This is remarkable for prominence of\nthe vascularity and several hypoechoic areas internally. There is no\nacoustical shadowing. This corresponds to the palpable lesion.\nIn the adjacent parenchyma there are at least 2 circumscribed anechoic masses\nmeasuring 6 mm and 4 mm, most consistent with oil cysts.", + "output": "Indeterminate 2.8 cm right breast mass at 8 o'clock corresponding to the\npalpable mass for which biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy with clip placement.\n\nNOTIFICATION: The findings and recommendation for biopsy were discussed with\nthe patient at the completion of the ultrasound. The patient notes that she\nis on many dose aspirin but is amenable to biopsy with the known risk of\nhematoma.\nPreliminary email sent to Dr. ___.\n\nThe patient was able to stay in the department for later same day biopsy.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "In the right breast 8 o'clock, 10 cm from the nipple there is a hyperechoic,\npoorly defined mass with associated cystic spaces. This was targeted for\nbiopsy. This is palpable.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised by\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "In the right breast 8 o'clock, 10 cm from the nipple there is a hyperechoic,\npoorly defined mass with associated cystic spaces. This was targeted for\nbiopsy. This is palpable.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised by\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 6\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is an approximately 8 x 5 x 5 cm seroma cavity in the right slightly\nlower outer breast, with surgical clips, marking the area of lumpectomy. \nThere are mild post radiation changes. There are numerous benign\ncalcifications, many representing calcified oil cysts. Vascular\ncalcifications are also noted. No spiculated mass, suspicious grouped\ncalcifications, or unexplained architectural distortion is seen.\n\nTargeted ultrasound of the right breast was performed with attention to the\narea of clinical concern as denoted by the patient. Patient reports small\nlumps at 1 o'clock, 5-7 cm from the nipple. In the ___ o'clock region, 5-9 cm\nfrom the nipple, in the superficial breast tissue, there are multiple small\nsub 5 mm cystic areas with internal echoes. These correspond to the palpable\nlumps and are felt to represent oil cysts and/or fat necrosis. While scanning\nthe patient she also reported intermittent pain in the area of the lumpectomy,\nat 8 o'clock, 9 cm from the nipple. In this area is a 4.8 x 1.8 x 3.6 cm\nfluid collection with multiple low-level internal echoes, consistent with a\nseroma/hematoma cavity.", + "output": "Expected post treatment changes in the right breast.\nPalpable lumps corresponding to probably benign complicated cysts, likely\nrelated to calcified oil cysts / fat necrosis.\n\nRECOMMENDATION(S): Clinical follow-up with six-month ultrasound follow-up of\nthe probably benign findings seen on ultrasound.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. She agrees with the plan. Findings were also called\nto ___, NP, who saw the patient following this study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nRight breast: There is a large circumscribed focal asymmetry in the right\nupper outer breast, in the area of lumpectomy, consistent with\nseroma/hematoma. There are numerous calcified oil cysts. There are other\nbenign calcifications and vascular calcifications. There are clips in the\nupper outer breast from cancer surgery. No suspicious dominant mass,\nsuspicious grouped calcifications, or unexplained architectural distortion is\nseen.\nLeft breast: There are benign calcifications and vascular calcifications. \nThere are lymph nodes in the left axillary tail. No suspicious dominant mass,\nsuspicious grouped calcifications, or unexplained architectural distortion is\nseen.\n\nTargeted ultrasound of the right upper inner breast was performed with\nattention to the area of prior sonographic abnormality. Again seen in the\nsuperficial breast at 1 o'clock, 5-7 cm from the nipple, are numerous sub 5 mm\nhypoechoic circumscribed masses, consistent with partially calcified oil cysts\nand or fat necrosis. Although the patient reports being asymptomatic, many of\nthese are palpable to my clinical exam. These correspond to the oil cysts\nseen on mammography. At 8 o'clock, 9 cm from the nipple is a complicated\nfluid collection measuring approximately 6 x 2 x 5 cm, consistent with\nseroma/hematoma. This has multiple internal echoes consistent with\ndebris/blood products. This is also palpable to my exam. No suspicious\nsonographic abnormality is seen.", + "output": "No specific mammographic or sonographic evidence for malignancy. Palpable\nareas in the right upper inner breast are consistent with partially calcified\noil cysts and/or fat necrosis. Larger palpable area in the right lateral\nbreast is consistent with seroma/hematoma.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere is no discrete mass associated with the BB on spot compression views,\nhowever, the right breast is remarkable for multiple calcified oil cysts; the\nlargest of which is 2 cm at 9 o'clock, anterior depth. Multiple other\ncalcified oil cysts are identified in the right breast predominantly in the\nupper outer quadrant and lateral breast. The left breast is without\nsuspicious dominant mass. Both breasts demonstrate benign calcifications.\nVascular calcifications are noted.\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right lateral breast\ndemonstrates several anechoic cystic lesions without through transmission\nconsistent with a calcified oil cysts. In the more lateral tissue it 8:30\no'clock 11 cm from the nipple there are 2 hyperechoic rounded masses measuring\n1.2 cm x 1 cm and 0.8 cm x 0.4 cm. These are consistent with non calcified\noil cysts or other benign entities. There is no suspicious dominant mass\nidentified.", + "output": "No evidence of malignancy. Multiple calcified oil cysts seen on mammography\nand ultrasound.\n\nRECOMMENDATION: Annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissues are heterogeneously dense which\nlowers the sensitivity of mammography. A biopsy clip is again seen in the\nupper outer posterior right breast in a region of residual fine punctate\ncalcifications. No cluster of suspicious microcalcifications, dominant mass\nor area of architectural distortion is appreciated in either breast.\n\nUltrasound of the right breast from ___ o'clock 2-8 cm from the nipple in the\narea of concern as indicated by the referring physician was performed. No\nsolid suspicious mass or cystic lesion is seen. Any decision to biopsy at\nthis time and further management of the patient's symptoms at this time should\nbe based on the clinical assessment.", + "output": "No focal mammographic or sonographic abnormality identified in the right\nbreast in the area of concern as indicated by the referring physician. Any\ndecision to biopsy at this time and further management of the patient's\nsymptoms at this time should be based on the clinical assessment.\n\nRECOMMENDATION: Annual screening mammography. The patient was also\ninstructed to followup with her physician for ___ clinical breast exam within\nthe next six months.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Transverse and sagittal images were obtained of the penis. Flow with normal\narterial waveforms was seen in the corpus spongiosum and the dorsal arteries\nthroughout the penis. Flow with normal arterial waveforms was seen in the\ncavernous arteries at the base of the penis, however in the mid and distal\npenis no flow was appreciated in the arteries of the corpora cavernosa\nbilaterally. No AV fistula was appreciated.", + "output": "No flow was seen in the arteries of the corpora cavernosa at the mid and\ndistal penis." + }, + { + "input": "There is normal respiratory variation in both common femoral veins. There is\nnormal compressibility and augmentation of both common femoral, superficial\nfemoral and popliteal veins. Normal compressibility and color flow are\ndemonstrated in the bilateral posterior tibial and peroneal veins. There is\nsoft tissue swelling on the right leg.", + "output": "No evidence of deep vein thrombosis in either lower extremity. Soft tissue\nswelling in the right leg." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a trace\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nUsing a needle guide, a 20-gauge needle was advanced into the largest fluid\npocket in the right upper quadrant and 15 cc of clear, straw-colored ascitic\nfluid was removed. Fluid samples were submitted to the laboratory for cell\ncount, differential, culture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic paracentesis, yielding 15\ncc of clear, straw-colored ascitic fluid. Not enough fluid was present for a\ntherapeutic drainage. Fluid samples were submitted to the laboratory for cell\ncount, differential, culture, and cytology." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 20 gauge spinal needle catheter was advanced into the largest fluid pocket\nin the right upper quadrant and 20 mL of clear, straw-colored fluid were\nremoved.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 20 mL of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.25 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 5.25 L of fluid were removed." + }, + { + "input": "Tissue density: The breast tissue is almost entirely fatty.\n\nBilateral diagnostic mammogram and bilateral breast ultrasound, demonstrate a\n1.8 x 0.4 x 1.8 cm asymmetric right retroareolar breast tissue consistent with\ngynecomastia, which correlates with palpable lump described by the patient in\nthe right breast.\n\nThere is of 3 mm focal asymmetry seen in the central left breast middle to\nposterior third, which does not persist on same day additional views, also\nwith no sonographic correlate on same day ultrasound.\n\nNo other abnormality seen in either breast and bilateral axillae", + "output": "No evidence of malignancy. Right breast gynecomastia.\n\nRECOMMENDATION: Followup and additional imaging only as clinically indicated.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breast tissue is almost entirely fatty.\n\nBilateral diagnostic mammogram and bilateral breast ultrasound, demonstrate a\n1.8 x 0.4 x 1.8 cm asymmetric right retroareolar breast tissue consistent with\ngynecomastia, which correlates with palpable lump described by the patient in\nthe right breast.\n\nThere is of 3 mm focal asymmetry seen in the central left breast middle to\nposterior third, which does not persist on same day additional views, also\nwith no sonographic correlate on same day ultrasound.\n\nNo other abnormality seen in either breast and bilateral axillae", + "output": "No evidence of malignancy. Right breast gynecomastia.\n\nRECOMMENDATION: Followup and additional imaging only as clinically indicated.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild to moderate atherosclerotic plaque in\nthe proximal ICA.\nThe peak systolic velocity in the right common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 117, 113, and 86 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 140 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild to moderate atherosclerotic plaque in\nthe proximal ICA.\nThe peak systolic velocity in the left common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 58, 62, and 52 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 127 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis (less than 40% bilaterally).\n\nMild to moderate atherosclerotic plaque in the proximal bilateral ICA at the\ncarotid bulbs.\n\nBilateral antegrade vertebral flow." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 108 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 72, 99, and 112 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 53 cm/sec.\nThe ICA/CCA ratio is 1..\nThe external carotid artery has peak systolic velocity of 165 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 121 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 97, 111, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 53 cm/sec.\nThe ICA/CCA ratio is 0.9..\nThe external carotid artery has peak systolic velocity of 160 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of significant stenosis in the internal carotid arteries\nbilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has significant heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 112 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 198, 143, and 126. Cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 251 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has significant heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 118 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 101, 159, and 136. Cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 228 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral 60- 69% ICA stenosis. Antegrade vertebral flow." + }, + { + "input": "The right kidney measures 10.6 cm. A simple cyst is demonstrated in the\ninterpolar region of the right kidney measuring 0.9 x 0.9 x 0.8 cm. The left\nkidney measures 11.7 cm. Simple cysts are evident on the left well with the\nlargest cyst in the interpolar region measuring 0.8 x 1.0 x 0.8 cm. There is\nminimal fullness of the collecting system on the left without frank\nhydronephrosis which improves post void. There is no hydronephrosis, stones,\nor masses bilaterally. Bilaterally, there is increased echogenicity of the\nrenal parenchyma. Normal corticomedullary differentiation is seen\nbilaterally.\n\nThe bladder is moderately well distended and normal in appearance. There is\nno postvoid residual.\n\nIncidental finding of splenomegaly measuring 14.5 cm.", + "output": "1. Increased echogenicity of the renal parenchyma bilaterally.\n2. Bilateral simple renal cysts.\n3. No postvoid residual.\n4. Minimal fullness of the left renal collecting system which improves\npostvoid.\n5. Incidental finding of splenomegaly." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 77, 94, and 82 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 0.91.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild intimal thickening and trace plaque.\nThe peak systolic velocity in the left common carotid artery is 91 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 86, 89, and 118 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 40 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 83 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Normal right carotid ultrasound.\n2. Mild intimal thickening and trace plaque within the left carotid artery\nwith isolated mildly increased velocities distally, given minimal plaque\nburden, mildly elevated velocities may relate partly to tortuosity, and\ntherefore felt most consistent with mild stenosis (<40%)." + }, + { + "input": "Rounded hypoechoic nodule with an echogenic vascular hilum is identified\nconsistent with a benign intramammary lymph node. The cortical thickness is\nnormal measuring less than 2 mm.", + "output": "Benign axillary lymph node accounting for the mammographic finding. There is\nno evidence of malignancy.\n\nRECOMMENDATION: Annual screening mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere has been interval development of a 9 mm oval, circumscribed mass in the\ncentral lower left breast. There are no associated calcifications. This mass\nwas targeted for same-day ultrasound.Left breast post treatment changes\ninclude mild architectural distortion and surgical clips are again seen. \nAgain seen are bilateral benign-appearing calcifications and stable\nasymmetries.\n\nBREAST ULTRASOUND: At 5 o'clock, 1 cm from nipple there is a hypoechoic mass\nwith indistinct margins measuring 0.9 x 0.4 x 1.1 cm with no internal\nvascularity; there is mild posterior acoustic shadowing. This mass correlates\nto the mammographic abnormality. There are normal appearing lymph nodes in\nthe axilla.", + "output": "There is a new suspicious left breast mass at 5 o'clock position 1 cm from the\nnipple.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy is recommended and\nhas been scheduled on ___ at 14:00. Findings were discussed with\nNP ___ on ___ at 1315.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere has been interval development of a 9 mm oval, circumscribed mass in the\ncentral lower left breast. There are no associated calcifications. This mass\nwas targeted for same-day ultrasound.Left breast post treatment changes\ninclude mild architectural distortion and surgical clips are again seen. \nAgain seen are bilateral benign-appearing calcifications and stable\nasymmetries.\n\nBREAST ULTRASOUND: At 5 o'clock, 1 cm from nipple there is a hypoechoic mass\nwith indistinct margins measuring 0.9 x 0.4 x 1.1 cm with no internal\nvascularity; there is mild posterior acoustic shadowing. This mass correlates\nto the mammographic abnormality. There are normal appearing lymph nodes in\nthe axilla.", + "output": "There is a new suspicious left breast mass at 5 o'clock position 1 cm from the\nnipple.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy is recommended and\nhas been scheduled on ___ at 14:00. Findings were discussed with\nNP ___ on ___ at 1315.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "In the left breast at 5 o'clock 1 cm from the nipple is a heterogeneous\nhypoechoic oval mass measuring 0.8 x 0.5 x 1.0 cm.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by P. ___,\nM.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The clip is on the medial inferior aspect of the mass. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement with the clip slightly medial. There are expected post biopsy\nchanges.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending The patient expects to hear the pathology results from ___\n___ NP in ___ business days. Standard post care instructions were\nprovided to the patient." + }, + { + "input": "In the left breast at 5 o'clock 1 cm from the nipple is a heterogeneous\nhypoechoic oval mass measuring 0.8 x 0.5 x 1.0 cm.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by P. ___,\nM.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The clip is on the medial inferior aspect of the mass. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement with the clip slightly medial. There are expected post biopsy\nchanges.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending The patient expects to hear the pathology results from ___\n___ NP in ___ business days. Standard post care instructions were\nprovided to the patient." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA ribbon clip is identified at the periphery of an oval circumscribed mass\nwithin the central lower left anterior depth breast, consistent with core\nbiopsy proven papilloma. Post treatment changes including architectural\ndistortion and surgical clips are stable. Benign-appearing calcifications\nremain as do focal asymmetries, unchanged. There is no suspicious grouped\nmicrocalcifications or unexplained areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. At\nthe 5 o'clock position approximately 1 cm from the nipple, a circumscribed\noval hypoechoic mass measures 0.6 x 0.6 x 0.7 cm, unchanged in size compared\nto ___. A clip is identified at its margin corresponding to\nmammographic finding.", + "output": "Left anterior breast mass with associated clip, core biopsy-proven papilloma\nwithout atypia, stable since ___.\nStable post treatment changes in the left breast.\n\nRECOMMENDATION(S): As it has been elected not to surgically excise the core\nbiopsy-proven papilloma, continued sonographic surveillance in another 6\nmonths is recommended. Patient will be due for annual bilateral mammogram at\nthat time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nThere is no new suspicious mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nPostsurgical changes in left breast are stable. There is a stable\nsubcentimeter focal asymmetry containing of ribbon shaped biopsy clip in the\nsubareolar lower left breast. 8 mm nodule in the upper anterior left breast\nis unchanged since ___.\n\nLeft BREAST ULTRASOUND: Oval hypoechoic mass at 5:00 position 1 cm from the\nnipple measuring 10 x 6 x 4 mm is unchanged since prior examination when it\nmeasured 11 x 6 x 5 mm.", + "output": "Stable appearance of previously biopsied papilloma at 5:00 position 1 cm from\nthe nipple in left breast.\n\nRECOMMENDATION(S): Diagnostic mammogram of the left breast in six-months for\ncontinued surveillance.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nThere is no new suspicious mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nPostsurgical changes in left breast are stable. There is a stable\nsubcentimeter focal asymmetry containing of ribbon shaped biopsy clip in the\nsubareolar lower left breast. 8 mm nodule in the upper anterior left breast\nis unchanged since ___.\n\nLeft BREAST ULTRASOUND: Oval hypoechoic mass at 5:00 position 1 cm from the\nnipple measuring 10 x 6 x 4 mm is unchanged since prior examination when it\nmeasured 11 x 6 x 5 mm.", + "output": "Stable appearance of previously biopsied papilloma at 5:00 position 1 cm from\nthe nipple in left breast.\n\nRECOMMENDATION(S): Diagnostic mammogram of the left breast in six-months for\ncontinued surveillance.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with some scattered\nfibroglandular tissue. There are stable right postsurgical changes and stable\nleft postsurgical changes. A ribbon clip is seen in the slightly inferior\ncentral left breast corresponding to the biopsy-proven papilloma. This area\nwas further evaluated with ultrasound. Several coarse bilateral breast\ncalcifications are again identified with no focal suspicious group seen.\n\nUltrasound of the left breast at 5 o'clock 1 cm from the nipple identifies a\nstable 1.1 x 0.4 x 0.8 cm solid intraductal predominantly avascular mass. \nGiven stability for ___ years, this continues to favor a benign finding and\ncontinued followup imaging in one year seems reasonable at this time.", + "output": "Stable probable benign left breast mass at 5 o'clock previously shown to\nrepresent a papilloma for which the patient opted for imaging follow-up rather\nthan excision. Continued followup imaging in one year seems reasonable at\nthis time.\n\nRECOMMENDATION: Bilateral diagnostic mammography and left breast ultrasound\nin one year.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nRight breast: Stable postsurgical changes are noted in the right breast. \nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nLeft breast: Stable post treatment changes are noted in the upper central left\nbreast. A ribbon clip in the slightly inferior central anterior left breast\ncorresponds to biopsy proven papilloma. There is no suspicious dominant mass,\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications.\nBREAST ULTRASOUND: Targeted ultrasound was performed. In the left breast at\n5 o'clock 1 cm from the nipple, there is a stable 1.3 x 0.5 x 0.7 cm\nhypoechoic mass without internal vascularity corresponding to the\nbiopsy-proven papilloma.", + "output": "1. No mammographic evidence of malignancy.\n2. Biopsy-proven papilloma in the left breast at 5 o'clock 1 cm from the\nnipple demonstrates ___ year stability.\n\nRECOMMENDATION(S): Risk and age based screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 54 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 50, 60, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 80 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 33, 51, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 97 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild/minimal plaque with normal velocities. Bilateral low-end ___ ICA\nstenosis" + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 15\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\n\nThere is mild heterogenous atherosclerotic plaque in the right internal\ncarotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 109 cm/s / 26 cm/s\nCCA Distal: 97 cm/s / 30 cm/s\nICA ___: 92 cm/s / 25 cm/s\nICA Mid: 103 cm/s / 20 cm/s\nICA Distal: 84 cm/s / 22 cm/s\nECA: 105 cm/s\nVertebral: 48 cm/s\n\nICA/CCA Ratio: 1.1\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 119 cm/s / 27 cm/s\nCCA Distal: 98 cm/s / 24 cm/s\nICA ___: 64 cm/s / 20 cm/s\nICA Mid: 62 cm/s / 25 cm/s\nICA Distal: 71 cm/s / 22 cm/s\nECA: 75 cm/s\nVertebral: 48 cm/s\n\nICA/CCA Ratio: 0.7\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA less than 40 percent stenosis.\nLeft ICA less than 40 percent stenosis." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nIn the right upper outer breast there is a 6 mm partially obscured mass which\npersists on spot compression views. There is no unexplained architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: A targeted ultrasound in the upper outer right breast was\nperformed. At the 9 o'clock position 4-5 cm from the nipple there are two\nadjacent oval circumscribed masses, the larger appearing anechoic, the smaller\ncontaining minimal internal echoes. These measure 3 x 3 x 6 mm and 4 x 2 x 4\nmm, respectively, and likely correspond to the mammographic abnormality.", + "output": "Two probable cysts, one with minimal internal debris at the 9 o'clock position\nin the right breast, corresponding to the mammographic abnormality.\n\nRECOMMENDATION(S): Given the patient's history of left breast DCIS, she has\nopted to undergo cyst aspiration at this time.\n\nNOTIFICATION: Findings were reviewed with the patient who requests\naspiration. She was given information and aspiration appointment ___ \n3:00p. Dr. ___ was emailed by Dr. ___ on ___ at\n10:30, 20 minutes after findings were made, for appropriate aspiration orders.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Pre-procedure scanning of the right breast re-identified two adjacent oval\ncircumscribed very hypoechoic/anechoic probable complicated cysts at 9 o'clock\n4-5cm from the nipple measuring 0.5 x 0.2 x 0.3cm and 0.3 x 0.4 x 0.2 cm,\nwhich were targeted for ultrasound-guided cyst aspiration.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into both lesions, which\nresolved. Trace straw-colored fluid was aspirated into the needle hub and\ndiscarded due to lack of suspicion. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast cysts.", + "output": "Technically successful US-guided aspiration of the two right breast cysts.\n\nFindings reviewed with the patient at the completion of the aspiration.\n\nStandard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation.\n\nRECOMMENDATION(S): Age and risk appropriate mammography." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 0.5 L of chylous ascitic fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, yielding 0.5 L of chylous ascitic fluid. Fluid samples were\nsubmitted to the laboratory for cell count, differential, and culture." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis. Additionally, a loculated fluid collection was\nseen in the left upper quadrant.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.0 L of turbid white fluid was removed. Additionally,\nunder real-time ultrasound guidance, a 5 ___ catheter was advanced into the\nloculated left upper quadrant fluid collection. 250 cc of clear straw-colored\nfluid was aspirated. Fluid samples were submitted to the laboratory for\nculture and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.0 L of turbid white free fluid was removed. Additionally, 250 cc of\nclear straw-colored fluid was aspirated from a loculated left upper quadrant\ncollection." + }, + { + "input": "There is a tiny posterior calcaneal spur. The Achilles tendon is mildly\nthickened near its insertion on the calcaneus measuring up to 1.0 cm in AP\ndiameter. No significant increased vascularity within the tendon. However,\nthere is overlying soft tissue swelling with trace edema and slight increased\nvascularity surrounding the tendon. Findings are suggestive of mild\ninsertional tendinosis without evidence of tear.", + "output": "Mild Achilles insertional tendinosis without evidence of tear." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\n\nRight breast: A marker is placed on the area of symptomatology. There is no\nmammographic finding to correlate with this palpable finding.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\n\nBREAST ULTRASOUND: Targeted sonography of the palpable finding which was\nassociated with skin bruising demonstrated a superficial hypo and hyperechoic\novoid lesion extending to the skin at 11 o'clock 5 cm from nipple measuring\napproximately 4 mm in diameter. This is most consistent with a tiny hematoma.", + "output": "Right breast: The palpable finding is a tiny hematoma associated with skin\nbruising. Continued clinical follow-up is recommended to resolution.\n\n\nRECOMMENDATION(S): Risk and age based screening\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with some scattered\nfibroglandular and fibronodular tissue which does somewhat lower the\nsensitivity of mammography. Scattered coarse dystrophic appearing\ncalcifications are seen in both breasts, a few of which are associated with\nsmall masses on tomosynthesis and therefore favor involuting fibroadenomas. \nNo area of architectural distortion or cluster of suspicious\nmicrocalcification is seen. Several more focal areas of nodularity in the\nouter posterior and upper right breast wrist seen on the initial CC and MLO\nviews, although only one appeared slightly persist on the additional imaging. \nThis was further evaluated with ultrasound.\n\nUltrasound of the right breast from ___ o'clock 5-15 cm from the nipple in\nthe area of concern on mammography was performed. At 10 o'clock 10-11 cm from\nthe nipple is identified a 0.5 x 0.3 x 0.4 cm benign-appearing intramammary\nlymph node. This likely accounts for the mammographic finding. No solid\nsuspicious mass or cystic lesion is seen.", + "output": "No specific mammographic evidence of malignancy.\n\nRECOMMENDATION: Routine mammography would be recommended based on age and\nrisk assessment.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with some scattered\nfibroglandular and fibronodular tissue which does somewhat lower the\nsensitivity of mammography. Scattered coarse dystrophic appearing\ncalcifications are seen in both breasts, a few of which are associated with\nsmall masses on tomosynthesis and therefore favor involuting fibroadenomas. \nNo area of architectural distortion or cluster of suspicious\nmicrocalcification is seen. Several more focal areas of nodularity in the\nouter posterior and upper right breast wrist seen on the initial CC and MLO\nviews, although only one appeared slightly persist on the additional imaging. \nThis was further evaluated with ultrasound.\n\nUltrasound of the right breast from ___ o'clock 5-15 cm from the nipple in\nthe area of concern on mammography was performed. At 10 o'clock 10-11 cm from\nthe nipple is identified a 0.5 x 0.3 x 0.4 cm benign-appearing intramammary\nlymph node. This likely accounts for the mammographic finding. No solid\nsuspicious mass or cystic lesion is seen.", + "output": "No specific mammographic evidence of malignancy.\n\nRECOMMENDATION: Routine mammography would be recommended based on age and\nrisk assessment.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Transverse and sagittal images were obtained without and with Valsalva as well\nas with patient in the upright position. A bowel containing hernia is\ndemonstrated in the region of the right inguinal canal. The neck of the\nhernia measures approximately 15 mm. The hernia appears to be partially\nreducible.", + "output": "Bowel containing hernia in the region of the right inguinal canal." + }, + { + "input": "Laparoscopic intraoperative ultrasound was provided to Dr. ___ planning\nof resection of a segment ___ liver lesion seen previously on MRI of ___. The mass was identified as a mildly hyperechoic nodule with internal\nvascularity measuring 1.7 x 1.3 cm, in immediately subcapsular location and\nwas localized with ultrasound for subsequent resection. The liver is diffusely\nnodular consistent with cirrhosis.\n\nPlease see the operative notes for further details.", + "output": "Laparoscopic intraoperative ultrasound with localization of a 1.7 x 1.3 cm\nsegment ___ liver lesion previously shown to be consistent with hepatocellular\ncarcinoma." + }, + { + "input": "9 mm hypoechoic subcutaneous nodule in the right upper quadrant.", + "output": "Successful ultrasound-guided biopsy of a subcutaneous hypoechoic nodule in the\nright upper quadrant. Pathology is pending" + }, + { + "input": "There is a 1.3 x 0.3 cm hypoechoic non loculated fluid collection in the\nsuperficial soft tissues of the left upper quadrant in the left breast, that\ncommunicate with skin defect.\nSurrounding this collection there is diffuse echogenic and mildly stranded\nsubcutaneous fat.", + "output": "Non-loculated subcutaneous fluid collection in the LUQ of the left breast. No\nevidence of well-defined abscess." + }, + { + "input": "DIGITAL DIAGNOSTIC MAMMOGRAM WITH CAD: The breast tissues are dense, lowering\nmammographic sensitivity. There is a dumb bell clip in the posterior left\nupper central breast from prior benign core biopsy. BB marker overlying the\nright axilla corresponds to area of clinical concern. This shows adjacent\nlymph nodes. No worrisome or spiculated mass, suspicious grouped\nmicrocalcifications, or unexplained distortion is seen.\nBREAST ULTRASOUND: Targeted ultrasound of the right axilla was performed. The\narea of clinical concern corresponds to 2 sonographically benign appearing\naxillary lymph nodes. These are not enlarged, have preserved echogenic fatty\nhila, and uniform thin cortex.\n\nTargeted ultrasound of the left upper breast was performed with attention to\nthe area of prior sonographic abnormality. At 11 o'clock, 5 cm from the nipple\nis a solid hypoechoic mass measuring 8 x 3 x 6 mm. There is no internal\nvascularity or posterior shadowing. Its long axis is parallel to the chest\nwall. Allowing for technical differences, appearances are stable since ___. No new cystic or solid mass is seen.", + "output": "1. Nearly ___ year stability of benign appearing solid left breast mass at 11\no'clock, most likely representing a fibroadenoma.\n2. Right axillary lump corresponding to benign appearing axillary lymph nodes.\n3. No specific evidence of malignancy.\n\nRECOMMENDATION: Annual screening mammography. Final disposition of clinical\nfindings should be based on clinical grounds.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has significant heterogeneous atherosclerotic\nplaque involving the internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 172, 104, and 52 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 76 cm/sec.\nThe ICA/CCA ratio is 2.9.\nThe external carotid artery has peak systolic velocity of 110 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild calcified atherosclerotic plaque\ninvolving the internal and external carotid arteries.\nThe peak systolic velocity in the left common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 68, 69, and 75 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 171 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. 60-69% stenosis of the right internal carotid artery\n2. Less than 40% stenosis of the left internal carotid artery" + }, + { + "input": "There is normal respiratory variation in both common femoral veins. There is\nnormal compressibility and augmentation of both common femoral, superficial\nfemoral and popliteal veins. Normal color flow is demonstrated in the\nbilateral posterior tibial and peroneal veins.", + "output": "No evidence of deep vein thrombosis in either lower extremity." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.9 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.2 L of clear yellow fluid were removed. Fluid samples\nwere submitted to the laboratory for chemistry, cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 6.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.5 L of amber colored fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.5 L of fluid were removed, with samples submitted for chemistry,\nhematology, and microbiology." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.5 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.5 L of serosanguinous fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 5.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.2 L of fluid were removed." + }, + { + "input": "LIVER: The liver is coarsened and nodular in echotexture. The contour of the\nliver is nodular, consistent with cirrhosis. There is no focal liver mass. The\nmain portal vein is patent with hepatopetal flow. The left and right portal\nveins are patent with normal directional flow. There is moderate ascites.\n\nBILE DUCTS: There is no intrahepatic biliary dilation. The CHD measures 7 mm.\n\nGALLBLADDER: The patient is status post cholecystectomy.\n\nPANCREAS: The pancreas is not well visualized, largely obscured by overlying\nbowel gas.\n\nSPLEEN: Normal echogenicity, enlarged measuring 17.0 cm, previously 17.3 cm.\n\nKIDNEYS: Limited views of the kidneys show no hydronephrosis.\n\nRETROPERITONEUM: The visualized portions of aorta and IVC are within normal\nlimits.", + "output": "1. Patent main, left and right portal veins with normal directional flow.\n2. Cirrhotic liver with sequela of portal hypertension, including moderate\nascites and splenomegaly of 17.0 cm.\n3. No focal liver mass lesions identified." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of bloody fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nquadrant and 5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Ultrasound-guided therapeutic paracentesis\n2. 2.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8.3 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8.3 L of fluid were removed from the right lower quadrant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 7.8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7.8 L of fluid were removed from the right lower quadrant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 1.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.25 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___. ___ the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.25 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.4 L of serosanguineous fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for chemistry, cell count,\ndifferential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.5 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3.5 L of fluid were removed." + }, + { + "input": "There is trace of intra-abdominal ascites.", + "output": "Trace ascites." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 78 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 76, 79, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 102 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 72, 77, and 67 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 0.96.\nThe external carotid artery has peak systolic velocity of 64 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No atherosclerotic plaque or hemodynamically significant stenosis visualized\nin the bilateral carotid arteries" + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 75.0 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 65.6, 73.9, and 69.2 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22.3 cm/sec.\nThe ICA/CCA ratio is 0.99.\nThe external carotid artery has peak systolic velocity of 101 cm/sec.\nThe vertebral artery is patent.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 113 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 76.8, 68.0, and 72.7 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20.5 cm/sec.\nThe ICA/CCA ratio is 1.07.\nThe external carotid artery has peak systolic velocity of 65.7 cm/sec.\nThe vertebral artery is patent.", + "output": "1. Moderate hard plaque at at the right carotid bulb and right ICA.\n2. Mild atherosclerotic plaque at the left carotid bulb, left ICA, and left\nECA.\n3. No hemodynamically significant stenosis." + }, + { + "input": "Right carotid:\nReal-time evaluation of the carotid bifurcation reveals mild heterogeneous\nplaque in the proximal internal carotid artery. Peak systolic and diastolic\nvelocities are as follows common carotid 70/19, proximal internal carotid\nartery ___ mid internal carotid artery ___ and distal internal carotid\nartery 68/28. Peak systolic velocity in the external carotid is 87 cm/second\nthe IC to CC ratio is 1.3\n\nLeft carotid:\nReal-time imaging of the carotid bifurcation reveals mild plaque at the\nproximal internal carotid artery. Peak systolic and diastolic velocities are\nas follows: Common carotid 57/10, proximal internal carotid 47/15, mid\ninternal carotid ___ and distal internal carotid 96/36. Peak systolic\nvelocity in the external carotid 55 cm/sec. The IC to CC ratio is 1.7\n\nFlow in both vertebral arteries is pro grade.", + "output": "1. Mild heterogeneous plaque involving the proximal internal carotid arteries\non both sides.\n\n2. No hemodynamically significant stenoses on either side. (Less than 40%).\n\n3. Antegrade flow both vertebral arteries." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The upper pole of the transplant kidney in the right iliac fossa\nwas targeted and 2 biopsy passes performed with a 16 gauge biopsy device.\n\nThe attending radiologist, Dr. ___, was present and supervising throughout the\nguidance.\n\nSEDATION: Local anesthesia was provided by 1% lidocaine. No moderate sedation\nwas administered.", + "output": "Ultrasound guidance for percutaneous transplant kidney biopsy." + }, + { + "input": "Targeted ultrasound of the right brachio-basilic arteriovenous fistula was\nperformed. The right brachial artery to basilic vein arteriovenous fistula is\npatent. On the inflow side, the brachial artery is patent with velocities up\nto 297 and 343 cm/sec. The brachial artery is tortuous with aneurysmal\ndilation of the brachial artery in the proximal arm up to 3.2 cm, previously\n1.5 cm. The basilic vein is patent with velocities of 406 cm/sec. The\ncephalic vein is patent.", + "output": "1. Aneurysmal dilation of the proximal brachial artery to 3.2 cm, previously\n1.5cm in ___.\n2. Patent right brachial basilic arteriovenous fistula.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 4:22 ___, 2 minutes after\ndiscovery of the findings." + }, + { + "input": "Left retroperitoneal fluid collection was aspirated to near complete\nevacuation.", + "output": "Successful US-guided near complete aspiration of a left lower quadrant\nlymphocele. Samples were sent for microbiology evaluation." + }, + { + "input": "Ultrasound-guided left abdominal collection drain placement as detailed above.\n1250 CC of serous Fluid was drained, catheter was attached to bag.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection." + }, + { + "input": "Large solid vascular lesion involving the medial aspect of the left clavicle\nwith extraosseous extension, similar to the appearance on recent CT. Images\ndemonstrate biopsy needle within the lesion.", + "output": "Technically successful ultrasound-guided biopsy of the medial left clavicle\nlesion." + }, + { + "input": "Targeted sonography of the lateral left breast demonstrated normal dense\nparenchymal architecture. No cystic, solid or shadowing Findings are\nidentified.", + "output": "Normal left breast targeted ultrasound. Continued clinical follow-up is\nrecommended.\n\nRECOMMENDATION(S): Clinical follow-up\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogenous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 90 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 182, 137, and 99 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 31\ncm/sec.\nThe ICA/CCA ratio is 2.0.\nThe external carotid artery has peak systolic velocity of 203 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 128 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 156, 103, and 102 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 29\ncm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 157 cm/sec.\nThe vertebral artery is patent with retrograde flow. The left brachial artery\nflow is monophasic suggesting proximal subclavian occlusive disease with steal\nphenomenon.", + "output": "Right ICA 60-69% stenosis.\nLeft ICA 60-69% stenosis.\nRetrograde left vertebral artery flow suggesting proximal subclavian occlusive\ndisease." + }, + { + "input": "Tissue density: There are scattered fibroglandular densities.\nThere is no dominant mass, architectural distortion or suspicious group of\nmicrocalcifications. A ribbon clip in the left inner lower breast at anterior\ndepth is present at the site of the biopsy-proven fibroadenoma. Triangular\nmarkers were placed over the patient's area of breast pain on the left. There\nis no specific finding at these markers.\n\nLEFT BREAST ULTRASOUND: Ultrasound was performed of the left breast in two\nareas of pain at 8 o'clock and 1 o'clock. At 8 o'clock 3 cm from the nipple at\nthe site of focal pain is a 4 x 2 x 4 mm oval hypoechoic lesion without\nposterior features or internal vascularity, most likely representing a cyst\nwith debris or a cluster of microcysts. No abnormality is detected at 1\no'clock, 2-7 cm from the nipple in the second area of pain.", + "output": "4 mm hypoechoic lesion in the left breast at 8 o'clock at the focal area of\npain without a mammographic correlate. This most likely represents a cyst with\ndebris or a cluster of microcysts and is probably benign.\n\nRECOMMENDATION: Six-month followup with ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: There are scattered fibroglandular densities.\nThere is no dominant mass, architectural distortion or suspicious group of\nmicrocalcifications. A ribbon clip in the left inner lower breast at anterior\ndepth is present at the site of the biopsy-proven fibroadenoma. Triangular\nmarkers were placed over the patient's area of breast pain on the left. There\nis no specific finding at these markers.\n\nLEFT BREAST ULTRASOUND: Ultrasound was performed of the left breast in two\nareas of pain at 8 o'clock and 1 o'clock. At 8 o'clock 3 cm from the nipple at\nthe site of focal pain is a 4 x 2 x 4 mm oval hypoechoic lesion without\nposterior features or internal vascularity, most likely representing a cyst\nwith debris or a cluster of microcysts. No abnormality is detected at 1\no'clock, 2-7 cm from the nipple in the second area of pain.", + "output": "4 mm hypoechoic lesion in the left breast at 8 o'clock at the focal area of\npain without a mammographic correlate. This most likely represents a cyst with\ndebris or a cluster of microcysts and is probably benign.\n\nRECOMMENDATION: Six-month followup with ultrasound.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "LEFT BREAST: At 8:00 o'clock, 3 cm from the nipple, there is a 4 x 2 x 2 mm\noval hypoechoic lesion which is unchanged in size and appearance of the prior\nexam. There is no internal vascularity or posterior features. There are a few\nvery thin hyperechoic nonvascularized linear foci within the lesion. This\nlikely represents a cyst with debris or a cluster of microcysts.\n\nRIGHT AXILLA: In the area of the patient's palpable concern in the right\naxilla, no abnormality is detected. There is no discrete mass or abnormal\nlymph node.", + "output": "1. Unchanged 4 mm hypoechoic lesion of the left breast, which is now stable\nfor 6 months. This likely represents a cyst with debris or a cluster of\nmicrocysts, and is probably benign. A followup ultrasound is recommended in 6\nmonths, which can be performed at the time of her annual mammography.\n2. No ultrasound correlate for the area of clinical concern in the right\naxilla. Further management should be based on the clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC LEFT MAMMOGRAM WITH CAD:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. An asymmetry in the central upper right breast is stable\nover multiple exams and is benign. A left breast percutaneous biopsy clip is\nnoted.\n\nLEFT BREAST ULTRASOUND: At 8 o'clock 3 cm from the nipple there is a 0.3 x\n0.1 x 0.3 cm anechoic mass that has the appearance of a cluster of cysts on\ntoday's exam and is different from the area that was previously imaged. The\npreviously noted area at 8 o'clock 3 cm from the nipple is not identified. No\nsuspicious masses are seen.", + "output": "No evidence for malignancy.\n\nRECOMMENDATION: Return to screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Ill-defined Fluid collection in the left lower quadrant noted on preprocedure\nimaging. This collection was drained and 8 ___ pigtail catheter insert as\ndescribed above.\n\nA previously inserted catheter more superiorly in the left mid abdomen was\nmanipulated and repositioned as described.", + "output": "1. Successful ultrasound-guided placement of ___ pigtail catheter into\nthe left flank fluid collection and aspiration of approximately 60 mL of\npurulent Fluid.\n2. Previously placed percutaneous catheter more superiorly in the left mid\nabdomen was manipulated, repositioned and approximately 30 mL of purulent\nfluid aspirated." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 28, 35, and 50 a cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 49 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 82 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 33, 47, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of significant stenosis in the internal carotid arteries\nbilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate soft and hard atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 89.1 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 94.4, 84.2, and 79.3 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 18.5 cm/sec.\nThe ICA/CCA ratio is 1.06.\nThe external carotid artery has peak systolic velocity of 158 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has extensive soft and hard atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 138 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 267, 139, and 122 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 49.3 cm/sec.\nThe ICA/CCA ratio is 1.93.\nThe external carotid artery has peak systolic velocity of 188 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate atherosclerotic plaque involving the right distal common carotid\nartery (s/p CEA), carotid bulb, and internal carotid artery causing no greater\nthan mild (___) right internal carotid artery stenosis.\n\nSevere atherosclerotic plaque involving the left distal common carotid artery,\ncarotid bulb, internal carotid artery causing severe (70- 79%) to borderline\nvery severe (80-99%) left internal carotid artery stenosis." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left lower quadrant transplant kidney was\ntargeted and 2 biopsy passes performed.\n\nSEDATION: This procedure was performed under local anesthesia. No sedation\nwas administered.", + "output": "Ultrasound guidance for percutaneous left lower quadrant transplant kidney\nbiopsy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a persistent asymmetry in the posterior right central breast in the\nMLO and lateral projections, not well seen in the CC projection. This area\nwas further assessed with ultrasound. In the right upper inner mid to\nposterior depth breast, spanning 7 mm, are amorphous calcifications which are\npredominately rounded although varying in size. These are new/ increased from\nthe prior mammograms. Stereotactic core biopsy is recommended for tissue\ndiagnosis. A few other scattered calcifications are seen but no other groups\nare identified. There is no unexplained distortion.\n\nTargeted ultrasound of the right central and outer breast was performed with\nattention to the area of right breast asymmetry. At 10 o'clock, 5 cm from the\nnipple, are 2 adjacent cysts, with overall dimension of 8 x 4 x 7 mm. This is\nfelt to correspond to the asymmetry on mammography. No solid or suspicious\nmasses seen on ultrasound.", + "output": "1. Amorphous, indeterminate, right upper inner breast calcifications.\n2. Right breast asymmetry on mammography felt to correspond to cysts on\nultrasound.\n\nRECOMMENDATION(S): Stereotactic core biopsy for right breast calcifications.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan. An informational brochure and an\nappointment slip were given to her prior to leaving the department.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a persistent asymmetry in the posterior right central breast in the\nMLO and lateral projections, not well seen in the CC projection. This area\nwas further assessed with ultrasound. In the right upper inner mid to\nposterior depth breast, spanning 7 mm, are amorphous calcifications which are\npredominately rounded although varying in size. These are new/ increased from\nthe prior mammograms. Stereotactic core biopsy is recommended for tissue\ndiagnosis. A few other scattered calcifications are seen but no other groups\nare identified. There is no unexplained distortion.\n\nTargeted ultrasound of the right central and outer breast was performed with\nattention to the area of right breast asymmetry. At 10 o'clock, 5 cm from the\nnipple, are 2 adjacent cysts, with overall dimension of 8 x 4 x 7 mm. This is\nfelt to correspond to the asymmetry on mammography. No solid or suspicious\nmasses seen on ultrasound.", + "output": "1. Amorphous, indeterminate, right upper inner breast calcifications.\n2. Right breast asymmetry on mammography felt to correspond to cysts on\nultrasound.\n\nRECOMMENDATION(S): Stereotactic core biopsy for right breast calcifications.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan. An informational brochure and an\nappointment slip were given to her prior to leaving the department.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "There is a moderate amount of subcutaneous edema along the dorsum of the foot.\nAlong the plantar aspect of the foot, adjacent to the first proximal phalanx,\nthere is a ill-defined heterogeneous hypoechoic region measuring approximately\n1.4 x 0.7 cm, which may represent phlegmon or an early complex fluid\ncollection. There is an additional smaller similar appearing hypoechoic\nregion along the dorsum of the foot overlying the first MTP, which measures 6\nx 1 mm.", + "output": "1. 1.4 cm ill-defined heterogeneous hypoechoic region along the plantar aspect\nof foot adjacent to the first proximal phalanx, which may represent phlegmon\nor early complex fluid collection.\n2. Similar-appearing 6 mm hypoechoic focus along the dorsum of the foot\noverlying the first MTP, possible small pocket of fluid.\n3. Moderate dorsal subcutaneous edema.\n\nRECOMMENDATION(S): MRI may be obtained to evaluate for intra-articular fluid\ncollections or osteomyelitis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: right lower quadrant\nFluid: 20 cc of serosanguinous fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 17 gauge needle advanced into the largest\nfluid pocket under real-time guidance.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 20 cc of serosanguineous fluid were removed and sent for requested\nanalysis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 62, 96, and 99 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 29\ncm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of 67 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 60, 70, and 99 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 35\ncm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant plaques or stenosis in the internal carotid\narteries" + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 14\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight breast:\n\nThere are multiple similar-appearing obscured masses consistent with a benign\nprocess. Most notably, in the superficial upper outer breast middle depth,\nthere is a circumscribed oval mass measuring 1.5 x 1.3 cm an obscured 1.4 cm\nmass in the lower inner breast middle depth which were further evaluated by\nultrasound.\n\nThere is no architectural distortion or suspicious grouped calcifications.\n\n\nLeft breast:\nThere are multiple similar-appearing obscured masses in the left breast, most\nnotably an obscured 1.6 cm mass in the upper breast and also an obscured 1.5\ncm mass the lower inner breast posterior depth.\n\nThere is a group of amorphous and round microcalcifications in the slightly\nlower inner breast middle depth spanning 0.4 x 0.3 cm, for which stereotactic\ncore biopsy is recommended.\n\nThere is no unexplained architectural distortion.\n\nBREAST ULTRASOUND:\n\nTargeted bilateral breast ultrasound was performed.\n\nRight breast:\n\nThe right breast was scanned at 5 o'clock in the the area of the physician\ndetected palpable lump. At 5 o'clock, 3-5 cm from the nipple there is a\ncircumscribed parallel oval hypoechoic mass measuring 1.1 x 0.4 x 1.3 cm\nwithout dominant vascularity or posterior acoustic shadowing. This correlates\nwith the obscured mass in the lower inner breast on mammography and is\nprobably benign likely representing a fibroadenoma, for which a six-month\nfollow-up right breast ultrasound is recommended.\n\nAt 11 o'clock, 3-5 cm from the nipple there is a circumscribed parallel oval\nhypoechoic mass measuring 1.6 x 0.6 X 1.3 cm without dominant vascularity or\nposterior acoustic shadowing. This correlates with the circumscribed mass in\nthe upper outer breast and is probably benign likely representing a\nfibroadenoma, for which six-month follow-up is recommended.\n\nLeft breast:\n\nThe left breast was scanned in the area of palpable clinical symptomatology as\ndirected by the patient. At 12 o'clock, 5 cm from nipple is an oval\nheterogeneously hypoechoic parallel mass with slight indistinct margins\nmeasuring 1.8 x 0.9 x 1.4 cm demonstrating posterior against enhancement\nwithout dominant vascularity. Ultrasound-guided core biopsy is recommended.\n\nIncidentally, there are multiple circumscribed avascular anechoic masses\ndemonstrating posterior acoustic enhancement, consistent with simple cysts,\nfor example most notably at 12:30, 5 cm from the nipple there are 2 adjacent\nsimple cysts which altogether measures 1.4 x 0.6 x 1.4 cm, and also at 12:30,\n6 cm from nipple measuring 0.5 cm.\n\nThe left breast was scanned in the area of the physician detected palpable\nlump at 6 o'clock. At 7 o'clock, 4-6 cm from nipple there is a circumscribed\nparallel oval hypoechoic mass measuring 1.3 x 0.4 x 1.1 cm without dominant\nvascularity or posterior acoustic shadowing. This is probably benign likely\nrepresenting a fibroadenoma, for which six-month follow-up is recommended.", + "output": "1. Indeterminate left breast mass on ultrasound at 12 o'clock, correlating\nwith the patient detected painful palpable lump, for which ultrasound-guided\ncore biopsy is recommended.\n2. Indeterminategroupedmicrocalcificationsinthelowerinnerleftbreast,forwhichst\nereotacticcorebiopsyisrecom" + }, + { + "input": "Left breast mass at 12 o'clock was again identified and targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and verbal informed consent was obtained due to\nCovid-19.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle and 14-gauge Bard spring-loaded biopsy device were used to\nobtain multiple cores. Next, a percutaneous ribbon clip was deployed under\nultrasound guidance.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: Deferred due to possible pregnancy.\n\nStandard post procedure instructions were discussed with the patient.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\nWhen the patient returns for stereotactic biopsy of right breast\ncalcifications a bilateral mammogram should be obtained to document the clip\nplaced in the left breast today.\n\nThe patient was instructed to return to us immediately after her next period\nfor stereotactic biopsy of right breast calcifications which were not\nperformed today as she stated she is actively trying to get pregnant and her\nlast period was about 2 weeks ago.\n\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nA port overlies the upper right breast obscures interpretation of this area. \nIn the upper outer right breast at posterior depth there is a focal asymmetry\nwith linear calcifications which are suspicious in morphology. Ultrasound was\nperformed for further evaluation given the presence of a focal asymmetry that\npersisted on spot compression views. There is no suspicious mass or\narchitectural distortion in either breast.\n\nBREAST ULTRASOUND: Ultrasound was performed of the upper outer right breast\nfrom ___ o'clock 0-14 cm from the nipple in the area of the mammographic\nfindings. No suspicious solid or cystic mass was identified.", + "output": "Suspicious calcifications in the right upper outer breast. The option of\nstereotactic core biopsy on a prone table was discussed with the patient\nhowever she did not feel that she would be able to undergo this procedure at\nthis time given her physical status. Other options would include upright\nstereotactic core biopsy at another facility or surgical consultation for\nneedle localization.\n\nRECOMMENDATION(S): Surgical consultation for possible excisional biopsy of\ncalcifications in the right upper outer breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nFindings also emailed to Dr. ___ by Dr. ___ on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nA port overlies the upper right breast obscures interpretation of this area. \nIn the upper outer right breast at posterior depth there is a focal asymmetry\nwith linear calcifications which are suspicious in morphology. Ultrasound was\nperformed for further evaluation given the presence of a focal asymmetry that\npersisted on spot compression views. There is no suspicious mass or\narchitectural distortion in either breast.\n\nBREAST ULTRASOUND: Ultrasound was performed of the upper outer right breast\nfrom ___ o'clock 0-14 cm from the nipple in the area of the mammographic\nfindings. No suspicious solid or cystic mass was identified.", + "output": "Suspicious calcifications in the right upper outer breast. The option of\nstereotactic core biopsy on a prone table was discussed with the patient\nhowever she did not feel that she would be able to undergo this procedure at\nthis time given her physical status. Other options would include upright\nstereotactic core biopsy at another facility or surgical consultation for\nneedle localization.\n\nRECOMMENDATION(S): Surgical consultation for possible excisional biopsy of\ncalcifications in the right upper outer breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nFindings also emailed to Dr. ___ by Dr. ___ on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThere are scattered areas of fibroglandular density. Questioned asymmetry is\nin the medial and central left breast have the appearance of normal breast\ntissue on subsequent spot compression views and 90 degree lateral view\nperformed today. No dominant mass, suspicious microcalcification, or\nunexplained architectural distortion is seen in either breast or relating to\nthe pain marker.\n\nLEFT BREAST ULTRASOUND:\n\nThe left breast was scanned in the areas of clinical concern in the lower\ninner breast and the outer central breast. No abnormality is identified.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION: Further management for the areas of clinical concern in the\nleft breast should be based on the clinical assessment. Age and risk\nappropriate screening mammography is recommended.\n\nNOTIFICATION: This was discussed with the patient.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B- There are scattered areas of fibroglandular density\nA circumscribed oval mass with a biopsy marking clip at the periphery\nrepresenting the biopsy-proven fibroadenoma in the left retroareolar region is\nstable in appearance since previous examination. There is no other dominant\nmass, unexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND:\n\nThe retroareolar region was scanned. In the 12 o'clock, 0 cm from the nipple\nthere is an intraductal solid mass representing the biopsy-proven papilloma. \nThis measures 0.3 x 0.2 x 0.3 cm and is sonographically stable in appearance\nsince ___ and smaller in size since ___.", + "output": "No evidence of malignancy. No imaging change in biopsy-proven left breast\npapilloma.\n\nRECOMMENDATION: No further imaging follow-up of the left breast papilloma is\nrequired. Patient may return to age and risk appropriate screening mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 5 mm round mass with partially circumscribed and partially obscured\nmargins, containing calcifications in the outer central left breast at mid\ndepth. There is a 4 mm group of punctate calcifications in the upper central\nleft breast. Additional scattered punctate calcifications are seen throughout\nthe outer upper left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the outer left breast was\nperformed. At 2:00 position 2 cm from the nipple there is a 5 mm cystic mass.\nAt 1:00 position 3 cm from the nipple there is an oval parallel circumscribed\nhypoechoic mass measuring 4 x 5 x 3 mm.", + "output": "1. There is an indeterminate mass in the outer central left breast containing\ncalcifications. It is likely that 1 of the circumscribed 5 mm masses at 1 or\n2 o'clock positions in the left breast correspond to the mammographic mass. \nUltrasound-guided cyst aspiration of both masses is recommended with a\npostprocedure mammogram to demonstrate resolution of the mammographic finding.\n\n2. There are indeterminate grouped calcifications in the upper central left\nbreast for which stereotactic guided core needle biopsy is recommended for\ntissue diagnosis. Management of the remainder of left breast calcifications\nwill depend on the results of the biopsy.\n\nRECOMMENDATION(S): Ultrasound-guided cyst aspiration in the left breast. \nStereotactic guided core needle biopsy in left breast.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. She was given information to schedule her biopsy\nappointment. The impression and recommendation above was entered by Dr.\n___ on ___ at 15:59 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Again seen in the left breast at 1 o'clock 3 cm from the nipple is a 0.4 x 0.5\nx 0.3 cm hypoechoic mass and at ___ o'clock 2 cm from the nipple a 0.5 x 0.5 x\n0.3 hypoechoic mass. Both of these lesions were targeted for aspiration.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___,\nM.D.(Attending).\n\nDescription: Using standard aseptic technique and 1% lidocaine for local\nanesthesia attention was first directed to the mass in the left breast ___\no'clock 2 cm from the nipple. Using a 16 gauge needle, this mass aspirated to\nresolution yielding yellow clear cystic fluid which was discarded due to lack\nof suspicion. Post-procedure scanning demonstrates no residual mass.\n\nUsing ultrasound guidance, aseptic technique and 1% lidocaine for local\nanesthesia, a 16 gauge needle was used to attempt to aspirate a mass in the\nleft breast at 1 o'clock 3 cm from the nipple. This failed cyst aspiration\nand therefore the procedure, with the patient's consent, was converted to an\nultrasound-guided core biopsy with clip placement. Next, a 13-gaugecoaxial\nneedle was placed adjacent to the lesion and using a 14-gauge Bard\nspring-loaded biopsy device, 7 cores were obtained. Next, a percutaneous\nribbon clip was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. The ribbon clip is associated with the mass at 1 o'clock mass. \nThe bow tie shaped clip is associated with the calcifications which were\nbiopsied with stereotactic guidance earlier today. No significant hematoma is\nseen.", + "output": "Technically successful US-guided core biopsy of a left breast mass at 1\no'clock and 6 S well ultrasound-guided aspiration of a cystic mass at ___\no'clock. Pathology is pending The patient expects to hear the pathology\nresults from the radiology department with results when they are available. \nStandard post care instructions were provided to the patient." + }, + { + "input": "Again seen in the left breast at 1 o'clock 3 cm from the nipple is a 0.4 x 0.5\nx 0.3 cm hypoechoic mass and at ___ o'clock 2 cm from the nipple a 0.5 x 0.5 x\n0.3 hypoechoic mass. Both of these lesions were targeted for aspiration.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___,\nM.D.(Attending).\n\nDescription: Using standard aseptic technique and 1% lidocaine for local\nanesthesia attention was first directed to the mass in the left breast ___\no'clock 2 cm from the nipple. Using a 16 gauge needle, this mass aspirated to\nresolution yielding yellow clear cystic fluid which was discarded due to lack\nof suspicion. Post-procedure scanning demonstrates no residual mass.\n\nUsing ultrasound guidance, aseptic technique and 1% lidocaine for local\nanesthesia, a 16 gauge needle was used to attempt to aspirate a mass in the\nleft breast at 1 o'clock 3 cm from the nipple. This failed cyst aspiration\nand therefore the procedure, with the patient's consent, was converted to an\nultrasound-guided core biopsy with clip placement. Next, a 13-gaugecoaxial\nneedle was placed adjacent to the lesion and using a 14-gauge Bard\nspring-loaded biopsy device, 7 cores were obtained. Next, a percutaneous\nribbon clip was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. The ribbon clip is associated with the mass at 1 o'clock mass. \nThe bow tie shaped clip is associated with the calcifications which were\nbiopsied with stereotactic guidance earlier today. No significant hematoma is\nseen.", + "output": "Technically successful US-guided core biopsy of a left breast mass at 1\no'clock and 6 S well ultrasound-guided aspiration of a cystic mass at ___\no'clock. Pathology is pending The patient expects to hear the pathology\nresults from the radiology department with results when they are available. \nStandard post care instructions were provided to the patient." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nNo suspicious masses, developing focal asymmetries or areas of architectural\ndistortion or clustered microcalcifications are seen on either sides. In the\nupper outer quadrant region where the patient states she has pain the majority\nof the tissue is fatty replaced as noted on prior exams. bBopsy marking\nclips are present in the left breast away from the area pain.\n\nBREAST ULTRASOUND: US of the left breast from ___ o'clock from 48 cm from the\nnipple in the area of pain indicated by the patient showed predominantly fatty\ntissue. No cystic or solid masses were seen", + "output": "No specific evidence of malignancy or other abnormality in either breast. No\nfindings to account for patient's diffuse laterally located pain in the upper\nleft breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Irregular, thick walled gallbladder with heterogeneous hypoechoic contents and\nirregular wall peripherally consistent with perforation. Multiple\nintrahepatic collections, better characterized on prior CT. Gallbladder was\naspirated to completion, with 20 cc purulent fluid removed. Postprocedure\nimages demonstrated no residual fluid content.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ngallbladder. More than 20 cc of purulent fluid were aspirated with samples\nwas sent for microbiology evaluation. No immediate postprocedure\ncomplication." + }, + { + "input": "Distended gallbladder as seen on prior CT and ultrasound. Previously placed\ncholecystostomy tube was visualized with tip in the liver parenchyma\ncorresponding with previously seen CT findings. Interval placement of a new\ncholecystostomy tube.", + "output": "1. Successful US-guided placement of ___ pigtail catheter into the\ngallbladder.\n2. Removal of previously placed percutaneous cholecystostomy tube." + }, + { + "input": "Unchanged distended gallbladder, as on prior ultrasound. No cholelithiasis\nidentified.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nAdditional views demonstrate a focal asymmetry in the lower inner left breast,\nwhich correlates with the mass seen on ultrasound, as described below.\n\nAdditional views demonstrate a 6 mm low-density, circumscribed, oval mass in\nthe outer central right breast at approximately the 9 to 10 o'clock position. \nNo ultrasound correlate for this mass was demonstrated.\n\nThere is no evidence of architectural distortion or suspicious grouped\nmicrocalcifications in either breast.\n\nBILATERAL BREAST ULTRASOUND: Targeted ultrasound of the left breast at the 7\no'clock position, 7 cm from the nipple demonstrates an approximately 7 mm\nhypoechoic, oval, well-circumscribed mass without internal vascularity or\nposterior features. This suggests a benign finding, such as a fibroadenoma.\n\nA targeted ultrasound of the right breast between the 8 and 11 o'clock o'clock\npositions demonstrates no sonographic abnormalities to correlate with the\nmammographic right breast mass.", + "output": "1. There is a 7 mm likely benign mass in the lower inner left breast, likely\ncorresponding to asymmetry density on the recent mammogram.\n\n2. There is a 6 mm likely benign mass in the outer central right breast at\nmid depth without sonographic correlate.\n\nRECOMMENDATION: Short term interval followup in 6 months with bilateral\ndiagnostic mammogram and a left breast ultrasound are recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nAdditional views demonstrate a focal asymmetry in the lower inner left breast,\nwhich correlates with the mass seen on ultrasound, as described below.\n\nAdditional views demonstrate a 6 mm low-density, circumscribed, oval mass in\nthe outer central right breast at approximately the 9 to 10 o'clock position. \nNo ultrasound correlate for this mass was demonstrated.\n\nThere is no evidence of architectural distortion or suspicious grouped\nmicrocalcifications in either breast.\n\nBILATERAL BREAST ULTRASOUND: Targeted ultrasound of the left breast at the 7\no'clock position, 7 cm from the nipple demonstrates an approximately 7 mm\nhypoechoic, oval, well-circumscribed mass without internal vascularity or\nposterior features. This suggests a benign finding, such as a fibroadenoma.\n\nA targeted ultrasound of the right breast between the 8 and 11 o'clock o'clock\npositions demonstrates no sonographic abnormalities to correlate with the\nmammographic right breast mass.", + "output": "1. There is a 7 mm likely benign mass in the lower inner left breast, likely\ncorresponding to asymmetry density on the recent mammogram.\n\n2. There is a 6 mm likely benign mass in the outer central right breast at\nmid depth without sonographic correlate.\n\nRECOMMENDATION: Short term interval followup in 6 months with bilateral\ndiagnostic mammogram and a left breast ultrasound are recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is an ovoid well-circumscribed mass measuring 0.6 cm in the mid-depth\ncentral outer right breast, stable compared to ___. This did not\nhave an ultrasound correlate on ultrasound performed in ___.\nThere is a focal asymmetry in the mid-depth lower inner left breast, also\nstable. There is no suspicious grouped microcalcifications or architectural\ndistortion. Parenchymal pattern is stable.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed. An ovoid\nhypoechoic well-circumscribed mass measuring 0.6 cm was identified at 7\no'clock 7 cm from the nipple, stable compared to ___. This mass\nprobably corresponds to the focal asymmetry seen on mammogram. No new mass was\nidentified.", + "output": "1. Right breast probable benign circumscribed mass with six-month stability on\nmammography.\n2. Left breast mass is stable on mammogram and ultrasound. Could represent a\nfibroadenoma. Given six-month stability continued followup recommended in 6\nmonth.\n\nRECOMMENDATION: Follow-up bilateral mammogram and left breast ultrasound is\nrecommended in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe right breast demonstrates a stable oval circumscribed 6 x 4 mm mass in the\nouter breast along the mid nipple line at middle to posterior depth. On one\nof the spot compression views this may have a fatty component and may\nrepresent an intramammary lymph node or other benign entity. The right breast\nis without suspicious mass or grouped microcalcification.\nThe left breast 7 mm focal asymmetry seen in the medial inferior breast on\nprior studies is less apparent and is only readily apparent on the CC views. \nOtherwise the left breast is without suspicious mass or grouped\nmicrocalcification.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast at 7 o'clock 7\ncm from the nipple again demonstrates an oval well-circumscribed 6 x 3 x 5 mm\nhypoechoic well-circumscribed mass. This is almost anechoic and may represent\na cyst with internal debris or other benign entity. There is no dominant\nvascularity or significant posterior features.", + "output": "___ year stability of benign right breast mass and left breast asymmetry, with\nan accompanying ultrasound correlate.\n\nRECOMMENDATION(S): ___ year followup diagnostic mammogram. Since the lesion in\nthe left breast seen on ultrasound is seen by mammography, followup left\nbreast ultrasound is not necessary.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe right breast demonstrates a stable oval circumscribed 6 x 4 mm mass in the\nouter breast along the mid nipple line at middle to posterior depth. On one\nof the spot compression views this may have a fatty component and may\nrepresent an intramammary lymph node or other benign entity. The right breast\nis without suspicious mass or grouped microcalcification.\nThe left breast 7 mm focal asymmetry seen in the medial inferior breast on\nprior studies is less apparent and is only readily apparent on the CC views. \nOtherwise the left breast is without suspicious mass or grouped\nmicrocalcification.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast at 7 o'clock 7\ncm from the nipple again demonstrates an oval well-circumscribed 6 x 3 x 5 mm\nhypoechoic well-circumscribed mass. This is almost anechoic and may represent\na cyst with internal debris or other benign entity. There is no dominant\nvascularity or significant posterior features.", + "output": "___ year stability of benign right breast mass and left breast asymmetry, with\nan accompanying ultrasound correlate.\n\nRECOMMENDATION(S): ___ year followup diagnostic mammogram. Since the lesion in\nthe left breast seen on ultrasound is seen by mammography, followup left\nbreast ultrasound is not necessary.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with some scattered\nfibroglandular tissue. An oval mass in the central outer right breast is\nstable consistent with a benign finding. An oval asymmetry in the slightly\ninner left breast is also unchanged consistent with a benign finding. No\nsuspicious mass, area of architectural distortion or cluster of suspicious\nmicrocalcification is seen in either breast.\n\nUltrasound of the left breast at 7 o'clock 7 cm from the nipple in the area of\nconcern on prior imaging identifies a stable 0.4 x 0.6 x 0.2 cm solid\nbenign-appearing lesion. Given stability for more than ___ years, this is\nconsistent with a benign finding and no further imaging followup is necessary\nat this time.", + "output": "Stable benign right breast mass and left breast asymmetry. Stable benign\nsolid mass in the left breast at 7 o'clock. No specific mammographic evidence\nof malignancy. The patient may resume routine screening.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 48, 49, and 74 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 69 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 52, 60, and 70 set cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 48 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis or significant atherosclerotic plaque." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n48/8 cm/sec in its proximal portion, 57/11 cm/sec in its mid portion, and\n66/11 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of 43/7\ncm/sec.\nThe external carotid artery has peak systolic velocity of 67 cm/sec.\nThe vertebral artery has peak systolic velocity of 60 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.5.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n64/11 cm/sec in its proximal portion, 59/12 cm/sec in its mid portion, and\n45/8 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 49/7\ncm/sec.\nThe external carotid artery has peak systolic velocity of 71 cm/sec.\nThe vertebral artery has peak systolic velocity of 58 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.2.", + "output": "No evidence of significant carotid artery stenosis bilaterally. Mild\nheterogeneous plaques in the bilateral carotid bulbs." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 0.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 0.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 30 cc of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 30 cc of fluid were removed." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate, homogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 104, 168, and 99 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 56 cm/sec.\nThe ICA/CCA ratio is 1.9.\nThe external carotid artery has peak systolic velocity of 143 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate, heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 118 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 129, 102, and 94 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 46 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 143 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Antegrade vertebral artery flow bilaterally.\n60-69% stenosis of the right internal carotid artery.\n40-59% stenosis of the Left internal carotid artery." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 34 cm/sec and\nhas significant late systolic blunting consistent with the known diagnosis of\nthe aortic stenosis.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 32, 26, and 25 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 9 cm/sec.\nThe ICA/CCA ratio is 0.9..\nThe external carotid artery has peak systolic velocity of 25 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 30 cm/sec and\nhas significant late systolic blunting consistent with the known diagnosis of\naortic stenosis.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 24, 33, and 44 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 10. Cm/sec.\nThe ICA/CCA ratio is 1.5..\nThe external carotid artery has peak systolic velocity of 21 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Minimal atherosclerotic plaque with bilateral widely patent carotid\nbifurcations. Doppler waveforms and diffusely low carotid velocities are\nconsistent with the known diagnosis of critical aortic stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 101, 89, and 70 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 55 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 124 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 95, 90, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 58 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "<40% stenosis in the bilateral ICAs." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 77, 94, and 85 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery is patent with antegrade flow, with peak systolic\nvelocity of 113 cm/s. .\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 77, 74, and 94 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 86 cm/sec.\nThe vertebral artery is patent with antegrade flow, with peak systolic\nvelocity of 73 cm/s.", + "output": "Elevated peak systolic velocity of the right vertebral artery that may be\nsuggestive of stenosis.\n<40% stenosis of the right internal carotid artery.\n<40% stenosis of the left internal carotid artery.\n\nRECOMMENDATION(S): Consider alternative imaging of the right vertebral artery\nto better determine possible stenosis given elevated velocity on Doppler.\n\nNOTIFICATION: Results were discussed with ___, PA on ___ @ 440PM" + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, two 18-gauge core biopsy passes were\nmade. The sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to\npathology." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 5 L total (5L maximum) of clear, green-yellow fluid were\nremoved. Fluid samples were submitted to the laboratory for cell count,\ndifferential, culture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nPlease note that the patient had complained of mild dizziness/lightheadedness\nprior to the exam that persisted after the exam. The patient's blood pressure\nsitting and lying supine were obtained and within normal limits:\nSupine - 122/70; Sitting upright-116/66.\nPatient uses a cane and we did not feel it was safe to repeat pressures while\nstanding in the procedure room. Instead, the patient was sent to the RCU for\nmonitoring and oral fluids.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. Total 5L of fluid were removed. Samples sent to pathology with results\npending at time of this dictation.\n3. Patient complained of mild dizziness/lightheadedness prior to and after the\nprocedure. Sitting and supine blood pressures were within normal limits. \nSent to ___ for oral fluids and monitoring.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 42 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 27, 47, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 45 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 32 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 29, 51, and 71 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 2.2.\nThe external carotid artery has peak systolic velocity of 41 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "<40% stenosis in the bilateral ICAs." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density. \nAdjacent to the BB marking the area of palpable concern there is an\napproximately 15 mm focal asymmetry in the upper slightly inner left breast,\nin the vicinity of the surgical scar marker. There are faint calcifications\nwithin the asymmetry. Extensive vascular calcifications are identified within\nthe left breast. A group of microcalcifications seen along the posterior\nmargin of the mass on the CC view, appears to be skin calcifications on the LM\nview. Left skin thickening is seen consistent with postradiation changes.\n\n\nBREAST ULTRASOUND: Focused ultrasound of the left breast, in the ___\no'clock position 8 cm from the nipple, an hypoechoic mass is seen measuring\napproximately 1.6 cm by 1.3 cm, with posterior acoustic shadowing however no\nappreciable internal vascularity. A linear hypoechoic scar is seen extending\nfrom this lesion to the cutaneous postsurgical scar.", + "output": "1. 1.6 cm hypoechoic mass in the ___ o'clock position of the left breast, 8\ncm from the nipple. This likely secondary to postop surgical changes/scar\nhowever an ultrasound-guided core needle biopsy is recommended to rule out\nmalignancy.\n\nRECOMMENDATION(S): Biopsy of the 1.6 cm hypoechoic left breast mass.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the left breast at 10 o'clock to 11 o'clock 8 cm from the nipple a\nhypoechoic mass measuring 1.6 cm with posterior acoustic shadowing with an\nadjacent linear hypoechoic scar corresponded to the area of palpable concern. \nThe area was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___ and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast palpable\nabnormality. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the left breast at 10 o'clock to 11 o'clock 8 cm from the nipple a\nhypoechoic mass measuring 1.6 cm with posterior acoustic shadowing with an\nadjacent linear hypoechoic scar corresponded to the area of palpable concern. \nThe area was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___ and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast palpable\nabnormality. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Adjacent to the surgical scar, in the area of clinical concern, there is skin\nthickening with 2.1 x 2.5 x 0.7 cm area of anechoic foci that have the\nappearance of a postsurgical fluid collection. This is not drainable. No\nsuspicious abnormalities identified.", + "output": "In the area of clinical concern, there is skin thickening with a small\ncollection secondary to postsurgical changes.\n\nRECOMMENDATION: Clinical followup.\n\nNOTIFICATION: This was discussed with the patient at time the exam.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the left chest area overlying the surgical scar, in the area of clinical\nconcern, there is moderate skin thickening with an associated predominantly\nanechoic fluid collection without internal vascularity, measuring 2.3 x 0.6 x\n1.6 cm, previously 2.1 x 2.5 x 0.7 cm. There may be a couple of internal\nseptations within this fluid collection.", + "output": "Perhaps minimal interval decrease in size of predominately anechoic fluid\ncollection in the left chest in the region of concern, now measuring 2.3 x 0.6\nx 1.6 cm, likely a seroma, with unchanged moderate skin thickening. Please\nnote that infection of this collection cannot be excluded on the basis of this\nexamination.\n\nInterval decrease in size of postsurgical fluid collection, \nnow measuring 2.3 x 0.6 x 1.6 cm with associated moderate skin thickening." + }, + { + "input": "Ultrasound was performed along the entire mastectomy scar medial and lateral\nto a small wound at the site of the prior incision and drainage. There is\nsignificant heterogeneity to subcutaneous soft tissues, particularly along the\nmedial aspect of the scar with associated hyperemia, likely representing edema\nand inflammatory changes for which clinical followup is recommended. The\nprevious fluid collection has resolved and there is no new drainable fluid\ncollection. The small palpable area indicated by ___, NP\nwho was present at the time of the ultrasound corresponds to a 3 x 2 x 1 mm\nfocal fluid collection within the skin. No discrete mass is identified.", + "output": "Significant inflammatory changes and edema of the soft tissues along the scar\nwithout a drainable fluid collection or definite focal mass. Clinical\nfollowup is recommended. Any decision to biopsy at this time should be based\non the clinical assessment.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient and with ___\n___, NP in person at the completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. Due to overlying bowel, no clear safe target was easily\nidentified. In addition, the patient did not want to have the procedure done\nbecause he said he felt better.", + "output": "Small volume ascites with bowel limiting safe access for paracentesis. In\naddition, patient declined to have the procedure. This was discussed with Dr.\n___." + }, + { + "input": "Tissue density: A- The breast tissues are predominantly fatty with minimal\nresidual fibroglandular tissue. There is at least two adjacent circumscribed\nmasses in the slightly upper outer right breast which were further evaluated\nwith ultrasound. There are no associated microcalcifications.\n\nUltrasound of the right breast at 11 o'clock 5 cm from the nipple\ncorresponding the area of concern on mammography identifies a focal area of\ncystic change measuring 1.8 cm in maximal dimension which has two dominant\nsimple cysts measuring 0.5 x 0.5 x 0.4 cm and 0.4 x 0.5 x 0.3 cm. Between the\ntwo dominant lesions are smaller hypoechoic areas likely representing\nadditional fibrocystic change, although these are indeterminate. Therefore,\nsix-month followup diagnostic mammography and ultrasound seems the most\nreasonable approach at this time..", + "output": "Probable benign fibrocystic changes in the right breast 11 o'clock likely\naccounting for the mass seen on the recent screening mammogram dated ___. Six-month follow-up right diagnostic mammogram and ultrasound\nseems the most reasonable approach at this time.\n\nRECOMMENDATION: Right diagnostic mammography and ultrasound in six months.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere is a 7 mm circumscribed mass in the upper outer right breast which is\nsimilar to the previous exam. The adjacent circumscribed mass has resolved. \nUltrasound was performed for further evaluation. There is no architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of concern. \nAt 10 o'clock 5 cm from the nipple there is a 0.6 x 0.5 by 0.7 cm anechoic\nsimple cyst corresponding to the mammographic finding. The previously\ndescribed adjacent cysts have resolved.", + "output": "Simple cyst in the right breast. No further imaging follow-up is required.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Focused imaging of the left breast at the 12 o'clock position, just superior\nto the nipple, overlying patient's area of pain, showed no drainable fluid\ncollection. Patient has a left breast implant.", + "output": "Focused imaging of the left breast at the 12 o'clock position, just superior\nto the nipple, overlying patient's area of pain, showed no drainable fluid\ncollection. Recommend short-term follow-up dedicated breast imaging in the\nbreast imaging clinic.\n\nRECOMMENDATION(S): Recommend short-term follow-up dedicated breast imaging in\nthe breast imaging clinic." + }, + { + "input": "At 3 o'clock there is an oval-shaped hypoechoic solid benign-appearing mass 3\ncm from the nipple measuring 1.1 cm by in 1.0 cm x 0.6 cm. There is peripheral\nare color flow and slight increase in through transmission. This mass appears\nbenign and corresponds to the medial lump noted by the patient.\nAt 6 o'clock where indicated by the patient 3 cm from the nipple there is a\nsimple cyst measuring 1 cm in diameter. This cyst corresponds to the a lump\nat 6 o'clock", + "output": "Solid mass in the inner aspect of the right breast is likely either a\nfibroadenoma or gestational change. The patient would prefer tissue diagnosis\nas an alternative to imaging followup. Ultrasound-guided core biopsy is\nscheduled for later this morning.\n\nSmall cyst at 6 o'clock.\n\nRECOMMENDATION: Ultrasound-guided core biopsy to follow imaging this morning.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the right breast at 3 o'clock 3 cm from the nipple there is an oval-shaped\nhypoechoic solid mass measuring 1.1 x 0.5 x 1.0 cm with surrounding and\ninternal vascularity.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P., ___, M.D.. The procedure was\nsupervised by V. ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine with epinephrine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nNo postprocedure mammogram was obtained as the patient is pregnant.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from Dr. ___ In ___\nbusiness days. Standard post care instructions were provided to the patient." + }, + { + "input": "There is no sonographic abnormality to correspond with palpable lump described\nby the patient at 11:00 - 1:00 2-7 cm from the nipple. The breast parenchyma\ndemonstrates changes related to lactation.", + "output": "No evidence of malignancy\n\nRECOMMENDATION: Age and risk appropriate screening\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is a fluid collection seen at the 9 o'clock location lateral to the\nbreast implant with some internal debris. This was the target for aspiration.\nThe collection with the patient positioned obliquely is 3.3 cm x 1.6 cm and\nextends inferiorly at least 5 cm. This was the target for aspiration.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D.\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the right breast fluid\ncollection lateral to the implant at 9 o'clock. 10 cc of fluid was aspirated.\nThe color was yellow, turbid. The needle was removed and hemostasis was\nachieved. Residual fluid was present. Repeat attempt at drainage was not\nsuccessful. As this was adjacent to the implant, additional attempts were not\nperformed. The tip of the needle was visualized at all times in did not enter\nthe implant.\n\nEstimated blood loss: 0 cc.\nSpecimens: Sent to micro bacteriology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Right breast fluid collection.", + "output": "Technically successful US-guided aspiration of the right breast fluid\ncollection at 9 o'clock.\n\nFindings reviewed with the patient at the completion of the aspiration.\n\nPostprocedure care is no heavy lifting." + }, + { + "input": "Targeted ultrasound of the right lateral breast surrounding the implant was\nperformed. At the patient's area of erythema at 9 o'clock lateral to the\nimplant, is a fluid collection with minimal debris, measuring 2.8 x 1.4 cm. \nThis extends inferiorly to the 6 o'clock location, and there is fluid seen\nmedially at 3 and 4 o'clock.", + "output": "Fluid surrounding the right breast implant. There is some debris noted at the\n9 o'clock location.\n\nRECOMMENDATION(S): Right breast aspiration requested and recommended with\nspecimens sent to micro bacteriology.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the area of pain and swelling surrounding the implant in the upper-outer\nquadrant there are changes of cellulitis with edema of the subcutaneous fat. \nThere as a small amount of ___ fluid at 9 o'clock position in the\nright breast with effusion thickness measuring approximately 1.9 x 1.5 cm. \nFor comparison, the inner aspect of the right breast implant was evaluated. \nThere is a small amount of fluid surrounding the medial aspect of the implant\nwith effusion thickness at 4 o'clock position measuring approximately 1.7 cm.\n\nUltrasound of the right axillary region was performed. There is no separate\nfluid collection identified. In the area of pain in the right axilla there is\na vague hypoechoic area measuring approximately 2.1 x 1.7 cm which may\nrepresent developing infection or represent an area of fat injection.", + "output": "Cellulitis in the upper-outer right breast/lower right axilla. Small amount\nof ___ effusion with no separate fluid collection in the upper-outer\nright breast/right axilla.\n\nRECOMMENDATION(S): Clinical followup is recommended. Dr. ___, MD\nwas notified of the above findings on the phone by Dr. ___ at 12:10 on ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: A targeted ultrasound from 3 - 6 o'clock 1-8 cm from the\nnipple was performed.\nIn the area pain as identified by the patient at 5 o'clock 1 - 8 cm from the\nnipple, there is normal fibroglandular tissue. While scanning at ___ o'clock\n5 cm from the nipple, there is a simple cyst incidentally that measures 0.6 x\n0.6 x 0.3 cm that is benign. There is no suspicious cystic or solid\nsonographic abnormality.", + "output": "1. There is no mammographic evidence of malignancy in either breast.\n2. There is no suspicious sonographic abnormality in the area of pain as\nidentified by the patient in the left breast.\n\nRECOMMENDATION(S): Annual mammography.\n\nRecommend clinical follow-up and final disposition of any clinical findings\nbased on clinical grounds. No further imaging follow-up is felt to be\nnecessary at this time.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: A targeted ultrasound from 3 - 6 o'clock 1-8 cm from the\nnipple was performed.\nIn the area pain as identified by the patient at 5 o'clock 1 - 8 cm from the\nnipple, there is normal fibroglandular tissue. While scanning at ___ o'clock\n5 cm from the nipple, there is a simple cyst incidentally that measures 0.6 x\n0.6 x 0.3 cm that is benign. There is no suspicious cystic or solid\nsonographic abnormality.", + "output": "1. There is no mammographic evidence of malignancy in either breast.\n2. There is no suspicious sonographic abnormality in the area of pain as\nidentified by the patient in the left breast.\n\nRECOMMENDATION(S): Annual mammography.\n\nRecommend clinical follow-up and final disposition of any clinical findings\nbased on clinical grounds. No further imaging follow-up is felt to be\nnecessary at this time.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 56, 71, and 60 were cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.92.\nThe external carotid artery has peak systolic velocity of 74 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 54 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 64, 57, and 54 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild bilateral internal carotid artery plaque without hemodynamically\nsignificant stenosis." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no suspicious mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast 11 o'clock 2 cm\nfrom the nipple demonstrates a cluster of the simple and complicated cysts\nwithout vascularity, which is stable in size and appearance and measures 2.9 x\n1.8 x 0.9 cm.\n\nTargeted ultrasound of the left breast 3 o'clock 2 cm from the nipple\ndemonstrates a cluster of cysts without vascularity, which is unchanged in\nsize and appearance and measures 1.6 x 1.1 x 0.4 cm", + "output": "1. ___ year stability of probably benign clusters of cysts in the left breast at\n11 o'clock and 3 o'clock positions.\n2. No mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S):\n1. Diagnostic left breast ultrasound in ___ year.\n2. Diagnostic bilateral mammogram in ___ year\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no suspicious mass, architectural distortion, or grouped\ncalcifications in either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast in the area of\nconcern demonstrated multiple, 1 cm and smaller, simple and complicated cysts\nat 11 and 3 o'clock, 2 cm from the nipple, for which six month follow-up is\nrecommended. There is no evidence of intraductal mass.", + "output": "Multiple simple and complicated cysts in the left breast, for which six-month\nfollow-up is recommended. No mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Left breast ultrasound in six months. Routine mammogram\nin one year.\n\nNOTIFICATION: Findings and recommendation were reviewed, through the ___\ninterpreter, with the patient who agrees with the plan. She was given\ninformation to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Ultrasound of the left upper inner and upper outer breast was performed in the\nareas of concern on prior imaging. At 11 o'clock approximately 2 cm from the\nnipple is a stable grouping of cystic changes, some being simple and others\ncomplicated which measures 1.7 x 1.0 x 0.6 cm in maximal ___. At 3\no'clock 2 cm from the nipple is a fluctuating area of cystic change measuring\n1.4 x 0.9 x 0.4 cm favoring a benign process such as apocrine metaplasia. \nContinued followup imaging in six months seems reasonable at this time.", + "output": "Stable and fluctuating cystic changes in the left breast at 11 o'clock and 3\no'clock for which continued followup imaging in six months seems reasonable at\nthis time.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and left breast ultrasound\nin six months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate degree of heterogeneous\natherosclerotic plaque centered around the carotid bulb region.\nThe peak systolic velocity in the right common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 75, 102, and 100 cm/sec, respectively. The peak systolic\nvelocity at the level of the carotid bulb is 209 cm/sec.\nThe peak end diastolic velocity in the right internal carotid artery is 24\ncm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 139 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has minimal degree of heterogeneous\natherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 100, 100, and 65 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 31\ncm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Significant degree of heterogeneous atherosclerotic plaque specifically at\nthe level of the right carotid bulb yielding a probable 60-69% degree\nstenosis. The velocities in the internal carotid artery itself are not\nelevated.\n2. Minimal heterogeneous atherosclerotic plaque in the left internal carotid\nartery yielding a less than 40% degree stenosis" + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nIn the upper outer breast a circumscribed 0.7cm mass persists. There are no\nassociated microcalcifications. This was further evaluated with ultrasound.\n\nBREAST ULTRASOUND: In the left breast at 1 o'clock 5 cm from the nipple\ncorresponding to the area of concern on mammography, there is an oval\nhypoechoic mass measuring 0.6 x 0.2 x 0.6 cm that demonstrates minimal\nposterior through transmission and no internal vascularity. Aspiration with\npossible core biopsy should be considered at this time. No additional solid\nor cystic masses are appreciated.", + "output": "Left breast mass at 1 o'clock for which aspiration with possible core biopsy\nis recommended at this time.\n\nRECOMMENDATION(S): Ultrasound-guided aspiration with possible core biopsy of\nthe left breast.\n\nNOTIFICATION: Findings and recommendation for aspiration were reviewed with\nthe patient and her daughter who agrees with this plan. She was given\ninformation to schedule her aspiration. Findings and recommendations were\nemailed to Dr. ___ by Dr. ___ on ___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Left breast at 1 o'clock 5 cm\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nTime-out certification: Performed using three patient identifiers. Allergies\nand/or Medications: Reviewed prior to the procedure.\nClinicians: ___, NP and ___, M.D.. T\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was advanced to the mass at 1 o'clock 5\ncm from the nipple and a scant amount of of cyst fluid was aspirated. The\nfluid was discarded due to lack of suspicion. The needle was removed and\nhemostasis was achieved.\n\nUnilateral digital diagnostic mammogram left breast: CC and mL views of the\nleft breast were obtained. These views demonstrate resolution of the mass in\nthe upper-outer quadrant demonstrated on previous imaging.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated left breast cyst.", + "output": "Technically successful US-guided aspiration of the left breast cyst.\n\nFindings reviewed with the patient at the completion of the aspiration. Annual\nmammography is recommended.\n\nStandard post care instructions were provided to the patient." + }, + { + "input": "Left breast at 1 o'clock 5 cm\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nTime-out certification: Performed using three patient identifiers. Allergies\nand/or Medications: Reviewed prior to the procedure.\nClinicians: ___, NP and ___, M.D.. T\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was advanced to the mass at 1 o'clock 5\ncm from the nipple and a scant amount of of cyst fluid was aspirated. The\nfluid was discarded due to lack of suspicion. The needle was removed and\nhemostasis was achieved.\n\nUnilateral digital diagnostic mammogram left breast: CC and mL views of the\nleft breast were obtained. These views demonstrate resolution of the mass in\nthe upper-outer quadrant demonstrated on previous imaging.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated left breast cyst.", + "output": "Technically successful US-guided aspiration of the left breast cyst.\n\nFindings reviewed with the patient at the completion of the aspiration. Annual\nmammography is recommended.\n\nStandard post care instructions were provided to the patient." + }, + { + "input": "Targeted ultrasound left axilla was performed over the palpable area.\nUnderlying the palpable area is a predominantly cystic lesion with a thick\nseptation within measuring 1.4 x 0.5 x 1.5 cm this shows posterior acoustic\nenhancement. The lesion is right under the dermis and accessory breast tissue\nis noted in the axilla. This is unlikely an abnormal lymph node .", + "output": "Probable benign complex cystic lesion in the left axilla. Patient is ___ weeks\npregnant. A short interval followup is recommended in ___ weeks.\nOption of ultrasound-guided aspiration/ FNA was discussed with the patient.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the left mid axilla was performed, at the patient's\narea of clinical concern. Again seen is a 1.5 x 0.6 x 1.3 cm cystic mass with\ninternal septations and echogenic debris layering in several cystic\ncomponents. There is no prominence of the vascularity. The size is similar to\nthe prior study. Adjacent axillary lymph nodes appear normal.", + "output": "1.5 cm cystic mass with septations and debris in the left axilla. This may\nrepresent a galactocele. If not, this is likely benign as it is fluctuating\nin size, according to the patient.\n\nRECOMMENDATION: 3 month followup. If the patient prefers aspiration, this\ncould be scheduled.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque at\nthe bifurcation.\nThe peak systolic velocity in the right common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 58, 61, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 0.82.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque at\nthe bifurcation, most pronounced within the bulb and internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 51, 59, and 62 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.84.\nThe external carotid artery has peak systolic velocity of 157 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild bilateral heterogeneous plaque, left greater than right. No\nhemodynamically significant stenosis of the carotid vasculature, bilaterally." + }, + { + "input": "Limited grayscale ultrasound imaging of the left hemithorax demonstrated a\nmoderate amount of septated/complex pleural fluid. A suitable target in the\ndeepest pocket in the left posterior mid scapular line was selected for\nthoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient's wife and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine buffered with\nsodium bicarbonate was instilled for local anesthesia.\n\nAn 8 ___ exodus catheter was advanced into the largest fluid pocket in the\nleft posterior mid scapular line and 30 cc of serosanguineous fluid was\nremoved and sent for analysis. The pigtail was formed. Catheter was secured\nto the skin using a stat lock. The catheter was then connected to a\nPleur-Evac.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated placement of an 8 ___ left pleural pigtail catheter" + }, + { + "input": "Intraoperative ultrasound guidance was provided to Dr. ___\nof a right renal mass and evaluation of multiple right renal cysts.\n\nPlease see the operative notes for further details.", + "output": "Intraoperative ultrasound examination of the right kidney. Please see the\noperative note for further details." + }, + { + "input": "The posted tibialis and flexor digitorum longus tendons are normal in\nechogenicity. No tear seen. No evidence of tenosynovitis. Corresponds to the\nsite of the patient's worse discomfort, at the medial aspect of the ankle,\nthere is a punctate hyperechoic focus seen closely related to what appears to\nbe the posterior tibial artery (series 1, images 21 and 25). The vessel is\npatent with normal flow. This may reflect a retained foreign body or\npotentially a small bony fragment from the initial fracture. This is not\ndefinitely seen on the prior radiographs.\n\nThere is mild thickening of the central band of the plantar fascia measuring\nup to 0.4 cm with mild adjacent hyperemia.\n\nThe overlying subcutaneous soft tissues appear unremarkable.", + "output": "1. Intact and normal appearing posterior tibialis tendon.\n2. A punctate hyperechoic focus closely related to the posterior tibialis\nartery with normal surrounding vascular flow is seen in the region of the\npatient's greatest discomfort. This may be situated within the wall of the\nartery with differential considerations including a small bony fragment\nrelated to the initial fracture versus a retained foreign body. This would be\na very unusual appearance for atherosclerotic calcification.\n3. Mild thickening of the central band of the plantar fascia which can be seen\nin the setting of plantar fasciitis, correlation with clinical examination\nfindings recommended." + }, + { + "input": "Corresponding to the mammographic finding at 11 o'clock in the subareolar\nregion is a 7 x 6 x 7 mm round hypoechoic mass. This has internal vascularity\nand increased through transmission. There is a 4 mm immediately adjacent mass\nas well more anechoic in nature and possibly a cyst. Ultrasound-guided biopsy\nof the larger hypoechoic mass is recommended.", + "output": "Hypoechoic mass at 11 o'clock corresponding to the mammographic finding. \nTissue sampling is recommended.\n\nRECOMMENDATION(S): Left breast ultrasound-guided biopsy. This will be\nperformed today.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. The findings were emailed to ___, M.D. by ___\n___, M.D. on ___ at 9:22 am.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "11 o'clock 6 x 7 x 7 mm mass was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss:\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement within the targeted mass.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "11 o'clock 6 x 7 x 7 mm mass was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and \nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous HydroMark coil was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss:\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement within the targeted mass.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Targeted breast ultrasound was performed in the area of mammographic mass in\nthe inner left breast. There is a circumscribed, anechoic mass with no\ninternal blood flow and with posterior acoustic enhancement measuring 0.6 x\n0.7 x 0.6 cm at ___ o'clock position 3 cmfn, compatible with a simple\ncyst. Otherwise, no suspicious solid or cystic masses were visualized in this\narea of mammographic mass.", + "output": "There is a 7 mm benign simple cyst in the inner right breast in the area of\nconcern on recent screening mammogram.\n\nRECOMMENDATION(S): Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\n\nThe rounded focal asymmetry is again seen in the upper, slightly inner left\nbreast, measuring 15 mm. This persists with spot compression imaging and was\ntargeted for further evaluation with ultrasound. There are no areas of\narchitectural distortion or suspicious microcalcifications in the left breast.\nThere are vascular calcifications.\n\nLEFT BREAST ULTRASOUND: Within the left breast at 11 o'clock, 2-3 cm from the\nnipple, there is an isoechoic mass, corresponding to the mammographic\nabnormality. The borders of the mass are irregular with a few linear\nprojections extending laterally. The mass measures 9 x 4 x 7 mm. There is no\ninternal vascularity or posterior shadowing.\n\nThe left axilla was interrogated and showed normal-appearing lymph nodes.", + "output": "Irregularly shaped mass in the upper, inner left breast corresponding to the\nmammographic abnormality for which ultrasound-guided biopsy is recommended.\n\nRECOMMENDATION: Ultrasound-guided left breast biopsy.\n\nNOTIFICATION: Findings were reviewed with the patient at the completion of\nthe study. Findings were also conveyed to Dr. ___ by Dr. ___ on ___ by email.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\n\nThe rounded focal asymmetry is again seen in the upper, slightly inner left\nbreast, measuring 15 mm. This persists with spot compression imaging and was\ntargeted for further evaluation with ultrasound. There are no areas of\narchitectural distortion or suspicious microcalcifications in the left breast.\nThere are vascular calcifications.\n\nLEFT BREAST ULTRASOUND: Within the left breast at 11 o'clock, 2-3 cm from the\nnipple, there is an isoechoic mass, corresponding to the mammographic\nabnormality. The borders of the mass are irregular with a few linear\nprojections extending laterally. The mass measures 9 x 4 x 7 mm. There is no\ninternal vascularity or posterior shadowing.\n\nThe left axilla was interrogated and showed normal-appearing lymph nodes.", + "output": "Irregularly shaped mass in the upper, inner left breast corresponding to the\nmammographic abnormality for which ultrasound-guided biopsy is recommended.\n\nRECOMMENDATION: Ultrasound-guided left breast biopsy.\n\nNOTIFICATION: Findings were reviewed with the patient at the completion of\nthe study. Findings were also conveyed to Dr. ___ by Dr. ___ on ___ by email.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "THERE IS A HYPOECHOIC MASS AT 11 O'CLOCK 2 CM FROM THE NIPPLE MEASURING 1.1 CM\nIN DIAMETER. THIS IS THE TARGET FOR ULTRASOUND-GUIDED CORE BIOPSY.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous HYDRO MARK was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\n\nSpecimens: Sent to Pathology.\nAnesthesia: 1% LIDOCAINE\nComplications: NONE\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.\nStandard post care instructions were provided to the patient.", + "output": "Successful ultrasound guided biopsy." + }, + { + "input": "THERE IS A HYPOECHOIC MASS AT 11 O'CLOCK 2 CM FROM THE NIPPLE MEASURING 1.1 CM\nIN DIAMETER. THIS IS THE TARGET FOR ULTRASOUND-GUIDED CORE BIOPSY.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous HYDRO MARK was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\n\nSpecimens: Sent to Pathology.\nAnesthesia: 1% LIDOCAINE\nComplications: NONE\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.\nStandard post care instructions were provided to the patient.", + "output": "Successful ultrasound guided biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild to moderate heterogeneous\natherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 46 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are , T9, and 47 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 18\ncm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 111 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild to moderate heterogeneousatherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 41 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 48, 59, and 62 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 16\ncm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "In the lower right axilla, there is a circumscribed oval mass measuring 12 x\n11 x 7 mm with hypoechoic rim and predominantly hyperechoic internal echoes as\nwell as multiple hypoechoic spaces. There is internal vascular flow on color\nDoppler.\n\nIn addition, in the right axilla 11 cm from the nipple, there are a few\nadjacent prominent lymph nodes with cortical thickening measuring 2-3 mm.", + "output": "Lower right axillary mass is indeterminate with low suspicion for malignancy.\n\nProminent right axillary lymph nodes with borderline cortical thickening\nprobably benign.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of lower right axillary mass\nseems reasonable.\n\nShort-term interval sonographic follow-up of right axillary lymph nodes in 6\nmonths seems reasonable.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan. She was given information to schedule her\nbiopsy and follow-up imaging. In addition, findings and recommendations were\ncommunicated by the critical results communication system to Dr. ___ at\n10:45 ___.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the right lower axilla is a well-defined lymph node/mass with\nhypoechoic/anechoic spaces. This measures 0.7 x 0.6 x 0.9 cm and targeted for\nbiopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by ___. ___,\nMD.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 16-gauge Achieve needle, 5 cores were obtained. Next, a\npercutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending The patient expects to hear the pathology results from the\nreferring provider ___ ___ business days. Standard post care instructions were\nprovided to the patient." + }, + { + "input": "Slightly prominent right axillary lymph nodes are again seen. On real-time\nscanning, there is a suggestion that some of these prominent nodes may\nrepresent a conglomerate of lymph nodes rather then 1 solitary abnormal node.", + "output": "Slightly prominent right axillary lymph nodes are not significantly changed\nand probably benign.\n\nRECOMMENDATION(S): Continued follow-up with ultrasound in 6 months is\nrecommended at which time the patient is due for a diagnostic bilateral\nmammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 15 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe 7 mm mass in the left upper central breast persist on additional\nspot-compression views. The several grouped microcalcifications in the left\nretroareolar region some of these are coarse heterogeneous groups. There are\nno spiculated masses or areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast performed. In the\nleft breast at 12 o'clock 3 cm from the nipple is a well-circumscribed\nhypoechoic lesion with some peripheral vascularity measuring 0.5 x 0.6 x 0.6\ncm which appears to be a complex cystic mass. This appears to correspond to\nthe mass seen on mammography.", + "output": "Mass in the left breast at 12 o'clock as described. Though this could\nrepresent a complicated cyst with debris a complex cystic mass cannot be\nexcluded and ultrasound-guided aspiration/ biopsy is recommended for\ndefinitive diagnosis.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The impression and recommendation above was entered by Dr. ___\n___ on ___ at 10:35 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Pre-procedure imaging re-identified a circumscribed complex cystic and solid\nlesion at 12 o'clock 3 cm from the nipple in the left breast measuring 0.6 x\n0.5 x 0.6 cm. This was targeted for vacuum assisted core needle biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, DO. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 11-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 12-gauge Celero vacuum-assisted biopsy\ndevice. Next, a percutaneous CeleroMark dumbbell was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement with adjacent post biopsy changes.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider,\nDr. ___, in ___ business days. Standard post care instructions\nwere provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Pre-procedure imaging re-identified a circumscribed complex cystic and solid\nlesion at 12 o'clock 3 cm from the nipple in the left breast measuring 0.6 x\n0.5 x 0.6 cm. This was targeted for vacuum assisted core needle biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, DO. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 11-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 12-gauge Celero vacuum-assisted biopsy\ndevice. Next, a percutaneous CeleroMark dumbbell was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement with adjacent post biopsy changes.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider,\nDr. ___, in ___ business days. Standard post care instructions\nwere provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "There is a small sebaceous cyst where indicated by the patient. The skin is\nsomewhat erythematous overlying of the nodule. The nodule measures 1 cm by\n0.6 cm. There is some flow internally suggesting that there may be some\nelement of inflammation.", + "output": "Sebaceous cyst involving the upper arm\n\nRECOMMENDATION: The patient was asked to by a warm compresses\n\nBI-RADS: 2 Benign." + }, + { + "input": "Mammogram:\n\nTissue density: The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere are no suspicious masses, areas of unexplained architectural distortion\nor suspicious grouped calcifications in either breast. No suspicious\nmammographic findings are identified in the upper inner left breast in the\narea of palpable concern, marked by a radiopaque skin marker.\n\nBREAST ULTRASOUND:\n\nRight breast: In the 2 o'clock position 6 cm from the nipple there is a 2.3 x\n0.7 x 1.4 cm gently lobulated parallel well-circumscribed hypoechoic mass with\nno definite internal vascularity and no posterior features. This mass\ncorresponds to the palpable lump identified by the patient. Adjacent to this\nmass medially and slightly inferiorly in the 2:30 o'clock position\napproximately 5 cm from the nipple there is a similar-appearing 7 x 10 x 2 mm\noval parallel hypoechoic mass. Additionally, in the 3 o'clock position\napproximately 3-4 cm from the nipple there is a 8 x 2 x 7 mm oval parallel\nhypoechoic circumscribed mass with several anechoic internal spaces. There is\nno definite internal vascularity.\n\nLeft breast: In the area of the indicated palpable concern in the 9 o'clock\nposition approximately 4 cm from the nipple there is a vague 7 x 3 x 4 mm\nisoechoic to hypoechoic parallel gently lobulated lesion, which may represent\na subtle isoechoic mass or lobular glandular tissue. There is no internal\nvascularity. There is no posterior acoustic features.", + "output": "1. Bilateral palpable lumps correspond to probably benign bilateral masses,\nlikely fibroadenomas. Short-term interval followup with bilateral breast\nultrasound in 6 months is recommended to document stability.\n\n2. There are 2 additional incidentally discovered masses in the right breast\nin the 230 and 3 o'clock positions, also probably benign. Short term follow up\nin 6 months with right breast ultrasound is recommended.\n\nRECOMMENDATION: Bilateral breast ultrasound in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Mammogram:\n\nTissue density: The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere are no suspicious masses, areas of unexplained architectural distortion\nor suspicious grouped calcifications in either breast. No suspicious\nmammographic findings are identified in the upper inner left breast in the\narea of palpable concern, marked by a radiopaque skin marker.\n\nBREAST ULTRASOUND:\n\nRight breast: In the 2 o'clock position 6 cm from the nipple there is a 2.3 x\n0.7 x 1.4 cm gently lobulated parallel well-circumscribed hypoechoic mass with\nno definite internal vascularity and no posterior features. This mass\ncorresponds to the palpable lump identified by the patient. Adjacent to this\nmass medially and slightly inferiorly in the 2:30 o'clock position\napproximately 5 cm from the nipple there is a similar-appearing 7 x 10 x 2 mm\noval parallel hypoechoic mass. Additionally, in the 3 o'clock position\napproximately 3-4 cm from the nipple there is a 8 x 2 x 7 mm oval parallel\nhypoechoic circumscribed mass with several anechoic internal spaces. There is\nno definite internal vascularity.\n\nLeft breast: In the area of the indicated palpable concern in the 9 o'clock\nposition approximately 4 cm from the nipple there is a vague 7 x 3 x 4 mm\nisoechoic to hypoechoic parallel gently lobulated lesion, which may represent\na subtle isoechoic mass or lobular glandular tissue. There is no internal\nvascularity. There is no posterior acoustic features.", + "output": "1. Bilateral palpable lumps correspond to probably benign bilateral masses,\nlikely fibroadenomas. Short-term interval followup with bilateral breast\nultrasound in 6 months is recommended to document stability.\n\n2. There are 2 additional incidentally discovered masses in the right breast\nin the 230 and 3 o'clock positions, also probably benign. Short term follow up\nin 6 months with right breast ultrasound is recommended.\n\nRECOMMENDATION: Bilateral breast ultrasound in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Ultrasound of the right breast identified the presence of 3 stable masses as\nfollows: 2 o'clock 6 cm from the nipple solid mass measuring 2.3 x 1.4 x 0.6\ncm; ___ o'clock 5 cm from the nipple solid mass measuring 1.0 x 0.4 x 0.9 cm;\nand 3 o'clock 3-4 cm from the nipple cystic appearing mass measuring 0.8 x 1.0\nx 0.3 cm with the largest cyst measuring 0.4 cm. Given stability, this\ncontinues to favor benign processes and continued followup imaging in 6 months\nseems reasonable at this time.\n\nUltrasound of the left breast at 9 o'clock 4 cm from the nipple identifies a\nstable 0.6 x 0.5 x 0.3 cm solid lesion. Continued followup imaging in 6\nmonths seems reasonable at this time.", + "output": "Bilateral stable probable benign masses in both breasts as described above for\nwhich continued followup imaging in 6 months seems reasonable at this time.\n\nRECOMMENDATION: Bilateral diagnostic mammography and bilateral breast\nultrasound in 6 months is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nScattered benign appearing calcifications are noted in both breasts without a\ndiscrete group. No dominant mass or unexplained architectural distortion is\nidentified.\n\nRIGHT BREAST ULTRASOUND: The areas that were previously evaluated were again\nimaged.\n1. 3 o'clock 3 cm from the nipple there is re- demonstration of a 0.9 x 0.7 x\n0.3 cm cluster of microcysts that is stable for ___ year.\n2. At 2 o'clock 6 cm from the nipple there is re- demonstration of a solid\nhypoechoic macro lobulated mass measuring 1.4 x 2.3 x 0.7 cm. This is also\nstable for ___ year.\n3. At 2:30 o'clock 5 cm from the nipple there is re- demonstration of a 0.9 x\n0.3 x 0.8 cm hypoechoic mass that is also stable for ___ year.\n\nLEFT BREAST ULTRASOUND: At 9 o'clock 3 cm from the nipple there is re-\ndemonstration of a stable 0.5 x 0.5 x 0.3 cm hypoechoic mass that also has the\nappearance of clustered microcysts. This is stable for ___ year.", + "output": "___ year stability of probably benign bilateral breast masses.\n\nRECOMMENDATION(S): Continued followup with bilateral ultrasound is\nrecommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.6 L of clear, straw-colored fluid were removed." + }, + { + "input": "There is no fluid collection in the groin. Normal arterial and venous\nwaveforms are demonstrated in the common femoral artery and vein,\nrespectively. There is no evidence of pseudoaneurysm.", + "output": "No evidence of pseudoaneurysm or fluid collection." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 51, 45, and 60 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 18\ncm/sec.\nThe ICA/CCA ratio is 0.6.\nThe external carotid artery has peak systolic velocity of 87 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 40, 58, and 53 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 24\ncm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 77 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Fluid collection was identified at the distal aspect of the femur at the\namputation site, approximately 5 cm from the anterior skin surface.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection, likely hematoma. Sample was sent for microbiology evaluation. No\nimmediate postprocedure complication." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal calcified atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 63, 75, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has minimal calcified atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 42, 59, and 62 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 91 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Findings consistent with less than 40% stenosis in the ICAs bilaterally." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the ___ into the\nlumen. Images were saved to the patient's permanent medical record.\n\nRight T6 radicular artery: Normal radicular artery. There is no opacification\nthe tumor blush\n\nRight T8 radicular artery: Normal jugular artery. No opacification the tumor\nblush\n\nRight T7 radicular artery: Significant tumor blush extending into the T7\nvertebral body\n\nRight T7 radicular artery micro injection: Evidence of tumor blush\nopacification\n\nRight T7 radicular artery after embolization: No opacification of the tumor\nblush\n\nLeft T9 radicular artery: There is some supplies the lower tumor blush as well\nas opacification of the T8 radicular artery which does not supply the tumor\nblush.\n\nLeft T7 radicular artery: Significant opacification of the tumor blush in the\nT7 and T8 vertebral bodies.\n\nLeft T7 radicular artery micro injection: Confirmation of supply to the tumor\nblush\n\nLeft T7 radicular artery after embolization: Significantly decreased flow to\nthe tumor blush\n\nMidthoracic aortogram: Opacification of the right T6, 7,8, 9 and 10 radicular\narteries as well as the left T5, T9, and T10 radicular arteries. There is no\nopacification of tumor blush.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "Uncomplicated embolization of bilateral T7 radicular arteries with supply to\nspinal tumor using embospheres and coils\n\nRECOMMENDATION(S): Care per primary team" + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.9 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.3 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.3 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ performed the key components of the procedure and\nreviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 7 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound-guided therapeutic paracentesis.\n2. 7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound-guided therapeutic paracentesis.\n2. 3.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.7 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.7 L of clear, straw-colored fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.1 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.1 L L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.95 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.95 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.6 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 15 mL of 1% lidocaine was\ninstilled for local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4.5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 13 mL of 1% lidocaine was\ninstilled for local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 1.3 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 10 mL of 1% lidocaine was\ninstilled for local anesthesia.\n\nUnder real-time ultrasound guidance, a 5 ___ ___ catheter was advanced\ninto the largest fluid pocket and 1.3 L of ascites fluid was aspirated.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.75 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.75 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.9 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.7 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.8 L L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. Removal of 4.8 L of fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: right lower quadrant\nFluid: 3.9 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 3.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.5 L of clear, straw-colored fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4.7 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.6 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 2.5 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe procedure was terminated early when the catheter dislodged due to patient\nmovement. The patient tolerated the procedure well without immediate\ncomplication. Estimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 2.5 L of fluid were removed. The procedure was terminated early when the\ncatheter dislodged due to patient movement." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.3 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.7 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5.1 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 3.9 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.6 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4.1 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: Left lower quadrant\nFluid: 3250 cc of clear straw-colored fluid\nSamples: 20 cc of peritoneal fluid was sent for lab analysis\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Successful left lower quadrant diagnostic and therapeutic paracentesis with\na total of 3250 cc clear straw-colored fluid removed.\n2. 20 cc sample of the peritoneal fluid was sent for lab analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 3.75 L of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.75 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of green-yellow fluid were removed. Fluid samples were\nsubmitted to the laboratory for chemistry, cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.65 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for biochemistry, cell count,\ndifferential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ performed the procedure.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.65 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.5 L of green-yellow fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 4.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.6 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.5 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.1 L of clear yellow fluid were removed. Fluid samples\nwere submitted to the laboratory for chemistry, cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 5.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.25 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.25 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.3 L of straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.3 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 5.75 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.75 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.95 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.95 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3.9 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.7 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.7 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.9 L of green-yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.9 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.9 L of straw-colored clear fluid were removed.\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Ultrasound-guided therapeutic paracentesis.\n2. 5.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.3 L of straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Ultrasound-guided therapeutic paracentesis\n2. 6.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.9 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 4.0 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.0 L of fluid were removed from the left lower quadrant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.0 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6.0 L of fluid were removed from the right lower quadrant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 7.7 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7.7 L of fluid were removed from the right lower quadrant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.5 L of pink-tinged fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6.5 L of pink-tinged fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 6.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6.5 L of fluid were removed." + }, + { + "input": "On clinical exam, a firm palpable lesion is detected in the inferior right\nbreast at 6 o'clock 7 cm from the nipple. The skin overlying this region is\nmildly erythematous. Patient reports tenderness to palpation.\n\nThe right breast was scanned between 6 and 7 o'clock, 4 through 7 cm from the\nnipple. Multiple dilated ducts are seen in this region. At 6 o'clock, 7 cm\nfrom the nipple there is an irregular echogenic area with indistinct margins\nwhich demonstrates minimal peripheral vascularity (image 13). No focal fluid\ncollection is detected.", + "output": "In the area of palpable concern, multiple dilated ducts are seen. An echogenic\nirregular area with indistinct margins demonstrates minimal peripheral\nvascularity and may represent fat necrosis. No focal fluid collection is\ndetected. The overlying skin is erythematous. Follow-up with breast care\ncenter is recommended for diagnostic imaging workup.\n\nRECOMMENDATION(S): Follow-up with breast care center is recommended for\ndiagnostic imaging workup.\n\nBI-RADS: 0 Incomplete - Need Additional Imaging \nEvaluation.\n\n\nIn the area of palpable concern, multiple dilated ducts are seen. An echogenic\nirregular area with indistinct margins demonstrates minimal peripheral\nvascularity and may represent fat necrosis. No focal fluid collection is\ndetected. The overlying skin is erythematous. Follow-up with breast care\ncenter is recommended for further diagnostic imaging workup." + }, + { + "input": "PICC line courses through the left basilic, axillary and subclavian veins. \nThere is occlusive thrombosis along the basilic vein about the catheter, and\nthe left cephalic vein is also thrombosed included. However, left internal\njugular, subclavian, axillary and paired brachial veins are widely patent\nwithout thrombosis.", + "output": "Findings consistent with superficial thrombophlebitis involving the basilic\nvein, along the course of the PICC line, as well as the cephalic vein. No\nevidence of extension into the deep venous system." + }, + { + "input": "The pancreas is difficult to visualize, possibly due to atrophy of the\ntransplant but also due to overlying large bowel gas which obscures deeper\nstructures. There is a hypoechoic structure which is felt likely to correspond\nto the transplant pancreas. The resistive index in what is likely the head\nmeasures 0.73, but the draining splenic vein is not well visualized. The\nentire course of the pancreas, as best seen on CTA abdomen from ___,\ncannot be visualized. There is no evidence of pancreatic duct dilation.", + "output": "Suboptimal visualization of the pancreas, likely due to a combination of\ntransplant atrophy and overlying bowel gas. The region of the pancreatic head\nis probably preserved, although the remainder of the pancreas and the draining\nsplenic vein is not well visualized. No evidence of pancreatic duct dilation.\n\nIf better evaluation of the pancreatic body and tail or the vascular supply\nand drainage is desired, contrast-enhanced CT/CTA should be considered." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: A marker is placed on the area of symptomatology. There is no\ndominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. There stable scattered calcifications which may be\ndermal in nature. Postsurgical changes of reduction mammoplasty noted.\n\nLeft breast: Postsurgical changes of reduction mammoplasty noted. In addition\nto scattered calcifications grouped calcifications in the superior central\nbreast noted without change. There is a circumscribed mass in the\ninferolateral subareolar region measuring 9.4 mm. An additional mass is\nidentified in the inferolateral posterior breast measuring 7 mm..\n\n\nBREAST ULTRASOUND:\nRight breast: Scans of the area of symptomatology as directed by the patient\ndid not demonstrate any cystic, solid or shadowing findings.\n\nLeft breast: In the lateral inferior subareolar region corresponding to the\nmammographic finding at 5 o'clock 2 cm from nipple is an ovoid cyst measuring\n0.7 x 0.3 x 1 cm. An additional septated cyst was identified at 4 o'clock 6\ncm from nipple measuring 5 x 4 x 5 mm.", + "output": "No mammographic evidence of malignancy.\n\nNo sonographic or mammographic abnormality in the area of symptomatology\ninvolving the upper outer right breast.\n\n2 benign left breast cyst identified.\n\nRECOMMENDATION(S): Risk and age based screening. Clinical evaluation of the\nright-sided pain.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is no evidence of ascites. Moderate splenomegaly noted.", + "output": "No ascites." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is re-demonstration of a 0.7 cm mass in the outer right breast. On 3D \nspot compression view, this area appears to have an irregular margin and may\ncontain calcifications. Based on 3D imaging this appears to be located in the\ncentral/inferior right breast. Further evaluation with ultrasound will be\nperformed.\n\nBREAST ULTRASOUND: The outer central right breast was scanned. At 9 o'clock\n4 cm from the nipple there is a 0.5 x 0.5 x 0.6 cm ill-defined hypoechoic area\nthat may correlate to the mammographic finding. The right axilla was scanned\nand no abnormal lymph nodes were seen.", + "output": "Indeterminate but suspicious right breast mass on mammography and ultrasound. \nNo abnormal lymph nodes.\n\nRECOMMENDATION(S): Right breast ultrasound-guided core biopsy.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The impression and recommendation above was entered by Dr. ___\n___ on ___ at 12:15 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Again seen is an ill defined hypoechoic region with posterior shadowing at the\n9 to 10:00 position right breast 4-5 cm from the nipple. This was targeted\nfor ultrasound-guided biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.. The procedure was supervised by ___, M.D.\n(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 10 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views demonstrate clip placement\nhowever, the biopsied ill-defined hypoechoic region does not correlate with\nthe mammographic finding which is located approximately 11 mm lateral to the\nbiopsy clip.\n\nA repeat ultrasound examination did not demonstrate any additional targeted\nlateral to the 1 that was biopsied.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending. The clip is not in the mammographic finding. If the\nbiopsy results are not malignant then a stereotactic breast biopsy of the\ninitially identified mammographic finding would be recommended for definitive\ndiagnosis.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Again seen is an ill defined hypoechoic region with posterior shadowing at the\n9 to 10:00 position right breast 4-5 cm from the nipple. This was targeted\nfor ultrasound-guided biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.. The procedure was supervised by ___, M.D.\n(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 10 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views demonstrate clip placement\nhowever, the biopsied ill-defined hypoechoic region does not correlate with\nthe mammographic finding which is located approximately 11 mm lateral to the\nbiopsy clip.\n\nA repeat ultrasound examination did not demonstrate any additional targeted\nlateral to the 1 that was biopsied.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending. The clip is not in the mammographic finding. If the\nbiopsy results are not malignant then a stereotactic breast biopsy of the\ninitially identified mammographic finding would be recommended for definitive\ndiagnosis.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Left BREAST ULTRASOUND:\n\nTargeted ultrasound was performed in the area of concern as indicated by the\npatient at 12:30 to 1 o'clock 7 cm from the nipple. Corresponding to a firm\npalpable lump in this area there is a 4.7 x 1.8 x 4.8 cm heterogeneous\nhypoechoic mass without internal vascularity that most likely represents fat\nnecrosis. The measurements likely underestimates the area involved. Given\nthat this may represent fat necrosis, mammography was performed.\n\nTissue density: A- The breast tissue is almost entirely fatty.\nSingle mL view was performed of the reconstructed breast. A BB marker is\nplaced in the area of concern. Underlying the BB marker there is a\napproximately 8.7 cm heterogeneous area which is interspersed with lucent fat\nconfirming that this most likely represents fat necrosis.", + "output": "Probable area of fat necrosis in the left breast for which six-month follow-up\nmammogram and ultrasound is recommended.\n\nRECOMMENDATION(S): Left diagnostic mammogram followed by ultrasound in 6\nmonths.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Left BREAST ULTRASOUND:\n\nTargeted ultrasound was performed in the area of concern as indicated by the\npatient at 12:30 to 1 o'clock 7 cm from the nipple. Corresponding to a firm\npalpable lump in this area there is a 4.7 x 1.8 x 4.8 cm heterogeneous\nhypoechoic mass without internal vascularity that most likely represents fat\nnecrosis. The measurements likely underestimates the area involved. Given\nthat this may represent fat necrosis, mammography was performed.\n\nTissue density: A- The breast tissue is almost entirely fatty.\nSingle mL view was performed of the reconstructed breast. A BB marker is\nplaced in the area of concern. Underlying the BB marker there is a\napproximately 8.7 cm heterogeneous area which is interspersed with lucent fat\nconfirming that this most likely represents fat necrosis.", + "output": "Probable area of fat necrosis in the left breast for which six-month follow-up\nmammogram and ultrasound is recommended.\n\nRECOMMENDATION(S): Left diagnostic mammogram followed by ultrasound in 6\nmonths.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Under ultrasound guidance, there are 2 subcentimeter collections in the\nsubcutaneous tissues of the lower abdomen. After administering local\nlidocaine, an 18 gauge needle was used to drain the 2 collections under\nultrasound guidance. The patient tolerated the procedure well.", + "output": "Successful ultrasound-guided aspiration of small subcutaneous loculated\ncollections." + }, + { + "input": "Tissue density: B- The breast tissues are fatty with some scattered\nmoderately dense fibroglandular fibronodular tissue which does somewhat lower\nthe sensitivity of mammography. There is a stable calcifying mass in the\ninner upper posterior right breast. The two circumscribed masses in the inner\ncentral left breast and upper outer left breast are stable continuing to favor\na benign process. No clusters of suspicious microcalcification or areas of\narchitectural distortion are appreciated in either breast.\n\nUltrasound of the left breast at ___ o'clock 11-12 cm from the nipple\nidentifies a stable 0.9 x 0.5 x 1.0 cm circumscribed mass. At 1 o'clock 15 cm\nfrom the nipple is identified a stable 1.9 x 0.8 x 1.9 cm mass of\nheterogeneous echotexture favoring a benign process such as a hamartoma. \nContinued followup imaging in one year seems reasonable at this time.", + "output": "Stable probable benign masses in the left breast at ___ o'clock and 1 o'clock\nfor which continued followup imaging in one year seems reasonable at this\ntime.\n\nRECOMMENDATION: Bilateral diagnostic mammography and left breast ultrasound\nin one year.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nMass in the upper central right breast with dystrophic calcifications is\nstable and represents a degenerating fibroadenoma. 2 masses in the inner\ncentral to slightly lower left breast and upper outer left breast are stable\nfor ___ years and are benign. There is no suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND:\nIn the left breast at 9 o'clock 11-12 cm from the nipple there is a hypoechoic\nmass that measures 0.9 x 0.7 x 0.4 cm. This is unchanged in size and\nappearance for ___ years and is benign.\n\nIn the left breast at 1 o'clock 15 cm from the nipple there is a mixed\nechogenic mass with a central hypoechoic component and a peripheral\nhyperechoic component that measures 1.6 x 1.5 x 0.6 cm. This is unchanged in\nsize and appearance for ___ years and is benign.", + "output": "There are 2 masses in the left breast that have been stable for ___ years\nconsistent with benign entities. No mammographic evidence of malignancy in\neither breast.\n\nRECOMMENDATION(S): Return to annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nMass in the upper central right breast with dystrophic calcifications is\nstable and represents a degenerating fibroadenoma. 2 masses in the inner\ncentral to slightly lower left breast and upper outer left breast are stable\nfor ___ years and are benign. There is no suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND:\nIn the left breast at 9 o'clock 11-12 cm from the nipple there is a hypoechoic\nmass that measures 0.9 x 0.7 x 0.4 cm. This is unchanged in size and\nappearance for ___ years and is benign.\n\nIn the left breast at 1 o'clock 15 cm from the nipple there is a mixed\nechogenic mass with a central hypoechoic component and a peripheral\nhyperechoic component that measures 1.6 x 1.5 x 0.6 cm. This is unchanged in\nsize and appearance for ___ years and is benign.", + "output": "There are 2 masses in the left breast that have been stable for ___ years\nconsistent with benign entities. No mammographic evidence of malignancy in\neither breast.\n\nRECOMMENDATION(S): Return to annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the right breast at ___ o'clock and 2 cm from the nipple corresponding to\nthe area of concern as indicated by the patient, there is an oval\nwell-circumscribed anechoic avascular mass measuring 1.9 x 1.5 x 1.7 cm,\ncompatible with a simple cyst. No solid lesion is seen.", + "output": "1.9 x 1.5 x 1.7 cm simple cyst in the right breast at ___ o'clock\ncorresponding to the area of concern as indicated by the patient.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe focal asymmetry in the upper outer breast somewhat persists in the MLO\nspot compression view and measures 5 mm but is not well seen on the CC spot\ncompression view. This area appears to possibly have been stable on more\nremote exams dating back until ___ and ___. Ultrasound was performed for\nfurther evaluation. There is no architectural distortion or suspicious\ngrouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of concern\non mammography. At 11 o'clock 10 cm from the nipple there is a 0.8 x 0.3 x 0\npoint 8 cm oval circumscribed hypoechoic mass which has the appearance of an\nintramammary lymph node however no definite fatty hilum or hilar blood flow\nwas identified. This is felt to correspond to the finding on mammography.", + "output": "Probable intramammary lymph node in the right breast corresponding to the\nfocal asymmetry on mammography for which six-month follow-up ultrasound is\nrecommended\n\nRECOMMENDATION(S): Right breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up..\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe focal asymmetry in the upper outer breast somewhat persists in the MLO\nspot compression view and measures 5 mm but is not well seen on the CC spot\ncompression view. This area appears to possibly have been stable on more\nremote exams dating back until ___ and ___. Ultrasound was performed for\nfurther evaluation. There is no architectural distortion or suspicious\ngrouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of concern\non mammography. At 11 o'clock 10 cm from the nipple there is a 0.8 x 0.3 x 0\npoint 8 cm oval circumscribed hypoechoic mass which has the appearance of an\nintramammary lymph node however no definite fatty hilum or hilar blood flow\nwas identified. This is felt to correspond to the finding on mammography.", + "output": "Probable intramammary lymph node in the right breast corresponding to the\nfocal asymmetry on mammography for which six-month follow-up ultrasound is\nrecommended\n\nRECOMMENDATION(S): Right breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up..\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the right breast at 11 o'clock 10 cm from the nipple, there is a 0.6 x 0.3\nx 0.4 cm almost anechoic mass with a hypoechoic component, previously\nmeasuring 0.8 x 0.3 x 0.8 cm, likely a cyst with debris.", + "output": "Probably benign 0.6 cm mass in the right breast is decreased in size since the\nprior study, likely a cyst with debris.\n\nRECOMMENDATION(S): Recommend six-month follow-up right breast ultrasound at\ntime of diagnostic bilateral mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Both jugular veins are grossly patent with expected spectral waveforms. \nPlease see the scanned documentation for specific measurements.", + "output": "Patent bilateral jugular veins." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 116 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 79, 97, and 99 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 114 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 93 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 83, 83, and 93 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral ___ stenosis (low end of range)." + }, + { + "input": "Targeted ultrasound at 9:30 o'clock 5 cm from the nipple demonstrates a 1.4 x\n0.8 x 0.8 cm irregular hypoechoic mass which was the target for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the right\nbreast lesion and using a 14-gauge Bard spring-loaded biopsy device, 5 cores\nwere obtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Targeted ultrasound at 9:30 o'clock 5 cm from the nipple demonstrates a 1.4 x\n0.8 x 0.8 cm irregular hypoechoic mass which was the target for biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, MD.\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gauge coaxial needle was placed adjacent to the right\nbreast lesion and using a 14-gauge Bard spring-loaded biopsy device, 5 cores\nwere obtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending.\n\nThe patient expects to hear the pathology results from her referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nFocal asymmetry is identified in the posterior upper-outer right breast\nspanning 12 mm with adjacent coarse benign calcification. The marker clip\nappears anterior and slightly lower than the focal asymmetry. Postsurgical\ndistortion is noted in the upper outer right breast.\n\nBREAST ULTRASOUND: Evaluation of the outer right breast was performed. At 10\no'clock, 7 cm from the nipple there is an irregular hypoechoic nodule\nmeasuring 12 mm x 8 mm x 11 mm. Distortion of the surrounding tissue is\nnoted. Coarse calcification is present within the nodule. This appears more\nposteriorly located and distinct from the previously sampled shadowing area at\n930.", + "output": "Suspicious hypoechoic nodule at 10 o'clock, 7 cm from the nipple.\n\nRECOMMENDATION(S): Same day ultrasound-guided core biopsy was performed.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nFocal asymmetry is identified in the posterior upper-outer right breast\nspanning 12 mm with adjacent coarse benign calcification. The marker clip\nappears anterior and slightly lower than the focal asymmetry. Postsurgical\ndistortion is noted in the upper outer right breast.\n\nBREAST ULTRASOUND: Evaluation of the outer right breast was performed. At 10\no'clock, 7 cm from the nipple there is an irregular hypoechoic nodule\nmeasuring 12 mm x 8 mm x 11 mm. Distortion of the surrounding tissue is\nnoted. Coarse calcification is present within the nodule. This appears more\nposteriorly located and distinct from the previously sampled shadowing area at\n930.", + "output": "Suspicious hypoechoic nodule at 10 o'clock, 7 cm from the nipple.\n\nRECOMMENDATION(S): Same day ultrasound-guided core biopsy was performed.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "The right breast nodule at 10 o'clock was identified.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using two patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___ .\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "The right breast nodule at 10 o'clock was identified.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using two patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___ .\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and\nmultiple cores were obtained using a 14-gauge Bard spring-loaded biopsy\ndevice. Next, a percutaneous clip was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has marked heterogeneous and calcified\natherosclerotic plaque, greatest within the proximal and mid ICA. There is\nmild intimal thickening throughout the right common carotid artery.\nThe peak systolic velocity in the right common carotid artery is 56 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 412, 436, and 230 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 142 cm/sec.\nThe ICA/CCA ratio is 7.8.\nThe external carotid artery has peak systolic velocity of 171 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous and calcified\natherosclerotic plaque, greatest within the carotid bulb and proximal ICA. \nThere is mild intimal thickening throughout the left common carotid artery.\nThe peak systolic velocity in the left common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 90, 83, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 74 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Marked heterogeneous and calcified plaque within the right carotid vasculature\nwith estimated 90% stenosis within the proximal and mid right ICA.\n\nMildly heterogeneous and calcified plaque within the left carotid vasculature\nwhich results in less than 40% stenosis." + }, + { + "input": "Targeted ultrasound of the right gluteal region demonstrates a large complex\nfluid collection with peripheral hypervascularity.", + "output": "Successful US-guided placement of ___ pigtail catheter into the right\ngluteal collection. Samples were sent for microbiology evaluation." + }, + { + "input": "Limited pre-procedure ultrasound demonstrates a fluid collection with internal\ndebris within the right gluteal musculature.", + "output": "Successful US-guided placement of an ___ pigtail catheter into the right\ngluteal fluid collection. A sample was sent for microbiology evaluation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful therapeutic paracentesis. A total of 4 L of fluid were\naspirated." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated\nmoderateascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 3 L of clear, reddish-tinged fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "3 L of clear, reddish ascitic fluid was removed from the right upper quadrant\nby ultrasound guidance." + }, + { + "input": "RIGHT:\nThere is no atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 103 cm/s / 14.2 cm/s\nCCA Distal: 96.7 cm/s / 21 cm/s\nICA ___: 87.6 cm/s / 24.4 cm/s\nICA Mid: 90 cm/s / 32.8 cm/s\nICA Distal: 77 cm/s / 28.8 cm/s\nECA: 110 cm/s\nVertebral: 78.7 cm/s\n\nICA/CCA Ratio: 0.93\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is no atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 101 cm/s / 16.5 cm/s\nCCA Distal: 93.3 cm/s / 23.8 cm/s\nICA ___: 79.2 cm/s / 25.2 cm/s\nICA Mid: 83.5 cm/s / 27.6 cm/s\nICA Distal: 76.7 cm/s / 27.5 cm/s\nECA: 121 cm/s\nVertebral: 64 cm/s\n\nICA/CCA Ratio: 0.89\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA: No stenosis.\nLeft ICA: No stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ was present for and personally supervised the entirety of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated ultrasound-guided therapeutic paracentesis via a right lower\nquadrant approach yielding 6 L of translucent, straw-colored ascites fluid." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA BB marker is placed in the left upper outer quadrant in the area of concern\nas indicated by the patient. No mammographic correlate is identified. \nUltrasound was performed for further evaluation. A clip in the lower inner\nleft breast marks the site of prior benign biopsy. There is no dominant mass,\nsuspicious grouped microcalcifications or architectural distortion in either\nbreast.\n\nBREAST ULTRASOUND: Ultrasound was performed in the area of concern as\nindicated by the patient in the left breast at 3 o'clock 7 cm from the nipple.\nNo solid or cystic mass was identified. Incidentally noted at ___ o'clock 4\ncm from the nipple is a 0.6 x 0.3 x 0.6 cm simple cyst.", + "output": "1. No mammographic or sonographic correlate for the area of concern in the\nleft breast. Clinical follow-up is recommended. Any decision to biopsy\nshould be based on clinical assessment.\n2. No specific evidence of malignancy in either breast.\n\nRECOMMENDATION(S): 1. Clinical follow-up of the left breast.\n2. Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nA BB marker is placed in the left upper outer quadrant in the area of concern\nas indicated by the patient. No mammographic correlate is identified. \nUltrasound was performed for further evaluation. A clip in the lower inner\nleft breast marks the site of prior benign biopsy. There is no dominant mass,\nsuspicious grouped microcalcifications or architectural distortion in either\nbreast.\n\nBREAST ULTRASOUND: Ultrasound was performed in the area of concern as\nindicated by the patient in the left breast at 3 o'clock 7 cm from the nipple.\nNo solid or cystic mass was identified. Incidentally noted at ___ o'clock 4\ncm from the nipple is a 0.6 x 0.3 x 0.6 cm simple cyst.", + "output": "1. No mammographic or sonographic correlate for the area of concern in the\nleft breast. Clinical follow-up is recommended. Any decision to biopsy\nshould be based on clinical assessment.\n2. No specific evidence of malignancy in either breast.\n\nRECOMMENDATION(S): 1. Clinical follow-up of the left breast.\n2. Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque,\ngreatest in the proximal ICA.\nThe peak systolic velocity in the right common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 69, 79, and 82 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 327 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 44 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 38, 71, and 18 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.8.\nThe external carotid artery has peak systolic velocity of 161 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% carotid stenosis bilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n44/12 cm/sec in its proximal portion, 77/12 cm/sec in its mid portion, and\n82/24 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n83/17 cm/sec.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery has peak systolic velocity of 37 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 0.98.\n\nLEFT:\nThe left carotid vasculature has mild calcified atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n59/16 cm/sec in its proximal portion, 92/25 cm/sec in its mid portion, and\n89/28 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 97/21\ncm/sec.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery has peak systolic velocity of 58 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.94.", + "output": "Mild bilateral carotid plaque. No hemodynamically significant stenosis." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast. Secretory calcifications are again\nnoted in the bilateral breasts. There is no specific abnormality seen along\nthe 3 o'clock location of the left breast.\n\nThe BREAST ULTRASOUND: Targeted ultrasound was performed in the left breast,\nfrom ___ o'clock, from 0-30 cm from the nipple which was without any discrete\nsuspicious solid or cystic masses.", + "output": "No mammographic or sonographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\nClinical followup of any areas of palpable concern.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There are a number of prominent ducts in the retroareolar area of both\nbreasts. No masses or shadowing abnormalities are seen. The axillary areas\nappeared normal bilaterally.", + "output": "Unremarkable screening bilateral breast ultrasonography and unremarkable\nevaluation of the axillary regions.\n\nRECOMMENDATION(S): Screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nNote the images are extremely limited with motion on the right-sided CC view\nthe right upper breast is not completely included on the images. There is no\nobvious mass on these limited images. There are no suspicious grouped\nmicrocalcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: The right breast was scanned with attention to the upper\nouter breast and at 12 o'clock. There is no discrete solid or cystic mass in\nthe right upper outer breast scanned and no masses identified at 12 o'clock. \nUnderlying the palpable area of concern at 12 o'clock 6-11 cm from the nipple.\nThere is no discrete solid or cystic mass. The irregular mass seen on the\ncine images from ___ appear to correspond shadowing from the nipple.", + "output": "No discrete mass in the area of concern at 12 o'clock.\nNote the mammogram images are extremely limited and if clinically indicated a\nrepeat mammogram could be obtained when the patient is stable.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nNote the images are extremely limited with motion on the right-sided CC view\nthe right upper breast is not completely included on the images. There is no\nobvious mass on these limited images. There are no suspicious grouped\nmicrocalcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: The right breast was scanned with attention to the upper\nouter breast and at 12 o'clock. There is no discrete solid or cystic mass in\nthe right upper outer breast scanned and no masses identified at 12 o'clock. \nUnderlying the palpable area of concern at 12 o'clock 6-11 cm from the nipple.\nThere is no discrete solid or cystic mass. The irregular mass seen on the\ncine images from ___ appear to correspond shadowing from the nipple.", + "output": "No discrete mass in the area of concern at 12 o'clock.\nNote the mammogram images are extremely limited and if clinically indicated a\nrepeat mammogram could be obtained when the patient is stable.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThere is mild homogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 170 cm/s /\nCCA Distal: 128 cm/s / 7 cm/s\nICA ___: 105 cm/s / 11.3 cm/s\nICA Mid: 98.4 cm/s / 12.4 cm/s\nICA Distal: 95.3 cm/s / 11.6 cm/s\nECA: 249 cm/s\nVertebral: 93.6 cm/s\n\nICA/CCA Ratio: 0.82\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild homogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 149 cm/s /\nCCA Distal: 126 cm/s / 0 cm/s\nICA ___: 108 cm/s / 12.6 cm/s\nICA Mid: 105 cm/s / 12.8 cm/s\nICA Distal: 105 cm/s / 12.4 cm/s\nECA: 158 cm/s\nVertebral: 117 cm/s\n\nICA/CCA Ratio: 0.86\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the axillary region of the right breast, there is a linear density which\nbecame pliable on additional spot compression views, compatible with normal\nbreast tissue. Grouped calcifications in the upper-outer left posterior\nbreast are more conspicuous than on prior examinations and are indeterminate.\n\nRight breast ultrasound: At the time of the ultrasound examination, the\npatient reported right breast pain and therefore evaluation of the right\nbreast was performed. It was only discovered after the patient left the\ndepartment that the left breast ultrasound to evaluate for left breast pain,\nas noted by triangle pain marker projecting of the left mammographic images,\nwas not performed.\n\nIn the right breast at ___ o'clock 10-15 cm from the nipple, in the palpable\nand painful area, normal breast tissue with seen. There is no evidence of\nmass or other abnormality.", + "output": "1. Calcifications in the left breast are indeterminate and stereotactic core\nbiopsy is recommended. These likely are benign given the additional scattered\ncalcifications throughout the left breast, however confirmation with\nhistologic sampling is recommended.\n\n2. No imaging abnormality in the right breast in the area of pain.\n\n3. No mammographic abnormality in the left breast in the area of pain, as\nnoted by the triangle pain marker on mammographic images. It was noted only\nafter the patient left the department, that no left breast ultrasound was\nperformed.\n\nRECOMMENDATION(S): 1. Stereotactic core biopsy of calcifications in the left\nbreast. Stereotactic biopsy has been scheduled for the morning of ___\n___.\n\n2. Patient was contacted and notified that she will also receive a left\nbreast ultrasound at no additional cost on ___ to\nfurther evaluate left breast pain.\n\n3. Further management for right breast pain should be based on the clinical\nassessment.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:09 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the axillary region of the right breast, there is a linear density which\nbecame pliable on additional spot compression views, compatible with normal\nbreast tissue. Grouped calcifications in the upper-outer left posterior\nbreast are more conspicuous than on prior examinations and are indeterminate.\n\nRight breast ultrasound: At the time of the ultrasound examination, the\npatient reported right breast pain and therefore evaluation of the right\nbreast was performed. It was only discovered after the patient left the\ndepartment that the left breast ultrasound to evaluate for left breast pain,\nas noted by triangle pain marker projecting of the left mammographic images,\nwas not performed.\n\nIn the right breast at ___ o'clock 10-15 cm from the nipple, in the palpable\nand painful area, normal breast tissue with seen. There is no evidence of\nmass or other abnormality.", + "output": "1. Calcifications in the left breast are indeterminate and stereotactic core\nbiopsy is recommended. These likely are benign given the additional scattered\ncalcifications throughout the left breast, however confirmation with\nhistologic sampling is recommended.\n\n2. No imaging abnormality in the right breast in the area of pain.\n\n3. No mammographic abnormality in the left breast in the area of pain, as\nnoted by the triangle pain marker on mammographic images. It was noted only\nafter the patient left the department, that no left breast ultrasound was\nperformed.\n\nRECOMMENDATION(S): 1. Stereotactic core biopsy of calcifications in the left\nbreast. Stereotactic biopsy has been scheduled for the morning of ___\n___.\n\n2. Patient was contacted and notified that she will also receive a left\nbreast ultrasound at no additional cost on ___ to\nfurther evaluate left breast pain.\n\n3. Further management for right breast pain should be based on the clinical\nassessment.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:09 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Targeted left breast ultrasound from 8 through 10 o'clock, 1-10 cm from the\nnipple at site of patient's pain demonstrates no sonographic abnormality. No\ncystic or solid mass is identified.", + "output": "No sonographic abnormality to correspond to left breast pain.\n\nRECOMMENDATION(S): Further imaging evaluation for breast pain should be\nwarranted by clinical examination. The patient went on to have stereotactic\ncore biopsy of left breast calcifications today, reported separately.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is an approximately 4 cm focal asymmetry in the lower central right\nbreast, best appreciated on the lateral and MLO views. Posterior to it also\nin the lower posterior right breast there is an 11 mm oval asymmetry without a\ncorrelate on the CC view. There are no associated calcifications or\ndistortions. No new suspicious abnormalities are seen in the left breast.\n\nBREAST ULTRASOUND: Ultrasound of the lower right breast was performed. At\n5:00 position 2 cm from the nipple there is a 1.5 x 1.5 x 0.7 mm hypoechoic\nirregular tissue with a hyperechoic rim, thought to correspond to the focal\nasymmetry on the mammogram. No sonographic correlate was seen to the second\nasymmetry in the posterior lower right breast.", + "output": "There is a developing focal asymmetry in the lower central right breast, for\nwhich a possible sonographic correlate was seen at 5:00 position 2 cm from the\nnipple. Tissue diagnosis is recommended for this finding. There is an 11 mm\nasymmetry with no sonographic correlate in the lower posterior right breast. \nDisposition of the second finding will be decided on the basis of the results\nof the biopsy.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. These findings were also reported to is referring\nclinician ___, NP via email by Dr. ___ on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is an approximately 4 cm focal asymmetry in the lower central right\nbreast, best appreciated on the lateral and MLO views. Posterior to it also\nin the lower posterior right breast there is an 11 mm oval asymmetry without a\ncorrelate on the CC view. There are no associated calcifications or\ndistortions. No new suspicious abnormalities are seen in the left breast.\n\nBREAST ULTRASOUND: Ultrasound of the lower right breast was performed. At\n5:00 position 2 cm from the nipple there is a 1.5 x 1.5 x 0.7 mm hypoechoic\nirregular tissue with a hyperechoic rim, thought to correspond to the focal\nasymmetry on the mammogram. No sonographic correlate was seen to the second\nasymmetry in the posterior lower right breast.", + "output": "There is a developing focal asymmetry in the lower central right breast, for\nwhich a possible sonographic correlate was seen at 5:00 position 2 cm from the\nnipple. Tissue diagnosis is recommended for this finding. There is an 11 mm\nasymmetry with no sonographic correlate in the lower posterior right breast. \nDisposition of the second finding will be decided on the basis of the results\nof the biopsy.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study. These findings were also reported to is referring\nclinician ___, NP via email by Dr. ___ on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "The right breast nodule at 5 o'clock, 2 cm from the nipple was identified.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___\n___: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous Seno Ribbon circle clip was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report with the results and the appropriate\nrecommendations." + }, + { + "input": "The right breast nodule at 5 o'clock, 2 cm from the nipple was identified.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: Dr. ___\n___: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous Seno Ribbon circle clip was deployed under ultrasound guidance.\nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report with the results and the appropriate\nrecommendations." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has homogeneous calcified atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 108, 75, and 119 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 34 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 91 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has homogeneous calcified atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 82, 87, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 107 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "40-59% stenosis of the right ICA. <40% stenosis of the left ICA." + }, + { + "input": "Redemonstration of the fluid collection in the left hemiabdomen/pelvis. This\nwas targeted for aspiration.", + "output": "Successful US-guided aspiration of a left hemiabdomen/pelvis collection.\nSamples were sent for microbiology and cytology evaluation. In light of these\nfindings, this fluid collection could be related to a left hemorrhagic cyst." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nThere is a mass in the left breast with associated calcifications in the upper\nouter quadrant of the left breastat middle depth measuring 1.5 cm.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in the right breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at 2 o'clock 2 cm\nfrom the nipple demonstrates a solid and cystic mass with echogenic foci,\nlikely representing associated calcifications measuring 1.4 x 0.6 x 1.3 cm. \nThis likely corresponds with the mammographic finding seen in the upper outer\nquadrant.\nAdditional targeted ultrasound of the left breast at 2 o'clock 7 cm from the\nnipple demonstrates simple cysts.", + "output": "1. Mass in the left breast at 2 o'clock 2 cm from the nipple is suspicious. \nRecommend ultrasound-guided core needle biopsy.\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the left breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The impression and recommendation above was entered by Dr. ___\n___ on ___ at 09:32 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "At 2 o'clock 2 cm from the nipple, there is an oval circumscribed mixed solid\nand cystic mass with internal calcifications measuring 1.7 cm, which was\ntargeted for ultrasound-guided core biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and verbal informed consent was obtained per\nCOVID-___ 19 crisis protocol.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ MD. ___ procedure was supervised by ___, M.D.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of left breast mass with\ncalcifications.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "At 2 o'clock 2 cm from the nipple, there is an oval circumscribed mixed solid\nand cystic mass with internal calcifications measuring 1.7 cm, which was\ntargeted for ultrasound-guided core biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and verbal informed consent was obtained per\nCOVID-___ 19 crisis protocol.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ MD. ___ procedure was supervised by ___, M.D.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of left breast mass with\ncalcifications.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAdditional imaging today is without a discrete asymmetry, focal asymmetry,\narchitectural distortion, suspicious dominant mass or grouped calcification. \nThe area of prior concern was likely overlapping glandular tissue.\n\nCOMPLETE LEFT BREAST ULTRASOUND: Targeted ultrasound of the left central\nbreast demonstrates heterogeneously dense parenchyma without suspicious solid\nor cystic mass.\nNext, the entire left breast was scanned (at all o'clocks) and appears normal.\nThe retroareolar region appears normal without dilated ducts. The left axilla\ndemonstrates normal-appearing lymph nodes.", + "output": "No specific evidence of malignancy in left breast.\nThe area of prior concern was likely overlapping glandular tissue.\n\nRECOMMENDATION(S): Return to annual screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Bilateral subpectoral silicone breast implants are in\nplace.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the subareolar right\nbreast which was without any discrete suspicious solid or cystic masses.", + "output": "There are no suspicious sonographic or mammographic findings in the subareolar\nright breast in the area of pain.\n\nRECOMMENDATION(S): Clinical follow-up of breast pain is recommended. Annual\nscreening mammography is also recommended.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Bilateral subpectoral silicone breast implants are in\nplace.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the subareolar right\nbreast which was without any discrete suspicious solid or cystic masses.", + "output": "There are no suspicious sonographic or mammographic findings in the subareolar\nright breast in the area of pain.\n\nRECOMMENDATION(S): Clinical follow-up of breast pain is recommended. Annual\nscreening mammography is also recommended.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 65, 72, and 71 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 96 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild originates plaque in the ICA.\nThe peak systolic velocity in the left common carotid artery is 92 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 78, 74, and 72 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 seconds cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous plaque in the left ICA resulting in less than 40% a\nstenosis. No atherosclerotic plaque and no stenosis seen in the right carotid\nsystem." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere are postoperative changes seen in the right upper outer quadrant similar\nto the priors with architectural distortion. A biopsy clip is noted similar\nto the priors. There are dystrophic calcifications and benign calcifications\nconsistent with calcified oil cysts seen in the right breast, consistent with\npost treatment changes.\nThe left breast demonstrates multiple benign calcifications consistent with\noil cysts similar to the priors. There is no new dominant mass, architectural\ndistortion or suspicious grouped calcification.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left upper central breast at\nthe patient's clinical area of concern demonstrates normal appearance of the\nbreast tissue without suspicious solid or cystic mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual mammography. Clinical followup for breast pain.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere are postoperative changes seen in the right upper outer quadrant similar\nto the priors with architectural distortion. A biopsy clip is noted similar\nto the priors. There are dystrophic calcifications and benign calcifications\nconsistent with calcified oil cysts seen in the right breast, consistent with\npost treatment changes.\nThe left breast demonstrates multiple benign calcifications consistent with\noil cysts similar to the priors. There is no new dominant mass, architectural\ndistortion or suspicious grouped calcification.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left upper central breast at\nthe patient's clinical area of concern demonstrates normal appearance of the\nbreast tissue without suspicious solid or cystic mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual mammography. Clinical followup for breast pain.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n33/11 cm/sec in its proximal portion, 76/19 cm/sec in its mid portion, and\n90/30 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n58/17 cm/sec.\nThe external carotid artery has peak systolic velocity of 52 cm/sec.\nThe vertebral artery has peak systolic velocity of 50 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.6.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n33/13 cm/sec in its proximal portion, 72/25 cm/sec in its mid portion, and\n58/23 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 62/17\ncm/sec.\nThe external carotid artery has peak systolic velocity of 51 cm/sec.\nThe vertebral artery has peak systolic velocity of 40 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.2.", + "output": "1. No plaque nor stenosis identified bilaterally." + }, + { + "input": "At 2 o'clock 5 cm from the nipple there is a 0.7 x 0.6 x 0.7 cm simple cyst. \nThis corresponds well to the mammographic finding.", + "output": "Right breast mass corresponds to a simple cyst\n\nRECOMMENDATION(S): Return to screening\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThe asymmetry in the right upper breast is somewhat pliable on spot\ncompression views. The left upper outer breast shows a discrete\nwell-circumscribed mass measuring 2.8 cm.\n\nBILATERAL BREAST ULTRASOUND: LEFT BREAST ULTRASOUND: Targeted ultrasound\nleft breast was performed. In the left breast at 2 o'clock 9 cm from the\nnipple is a well-circumscribed anechoic lesion measuring 2.5 x 1.6 x 2 cm with\nposterior acoustic enhancement and no vascularity. This is consistent with a\nsimple cyst.\n\nRight breast ultrasound: Targeted ultrasound the right breast was performed.\nIn the right breast at 12 o'clock 3 cm from nipple is a 1.8 x 0.9 by 1 cm\nsimple cyst also at 1 o'clock 4 cm from the nipple is a simple cyst measuring\n1 x 0.4 x 1 cm. No solid lesion of concern.", + "output": "Multiple simple cysts as described. No evidence of malignancy.\n\nRECOMMENDATION: Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThe asymmetry in the right upper breast is somewhat pliable on spot\ncompression views. The left upper outer breast shows a discrete\nwell-circumscribed mass measuring 2.8 cm.\n\nBILATERAL BREAST ULTRASOUND: LEFT BREAST ULTRASOUND: Targeted ultrasound\nleft breast was performed. In the left breast at 2 o'clock 9 cm from the\nnipple is a well-circumscribed anechoic lesion measuring 2.5 x 1.6 x 2 cm with\nposterior acoustic enhancement and no vascularity. This is consistent with a\nsimple cyst.\n\nRight breast ultrasound: Targeted ultrasound the right breast was performed.\nIn the right breast at 12 o'clock 3 cm from nipple is a 1.8 x 0.9 by 1 cm\nsimple cyst also at 1 o'clock 4 cm from the nipple is a simple cyst measuring\n1 x 0.4 x 1 cm. No solid lesion of concern.", + "output": "Multiple simple cysts as described. No evidence of malignancy.\n\nRECOMMENDATION: Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Complex subhepatic / gallbladder collection correlating with the finding seen\non recent CT.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\nsubhepatic / gallbladder fossa fluid collection. Samples was sent for\nmicrobiology evaluation.\n\nRECOMMENDATION(S): Recommend flushing aspirating the catheter with 10 cc\nnormal saline daily.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 12:12 pm, 1 minutes after discovery of the\nfindings." + }, + { + "input": "The spleen measures 12.5 cm in maximum diameter, and appears normal and\nhomogeneous in echogenicity.", + "output": "Borderline spleen size measuring up to 12.5 cm." + }, + { + "input": "In the right breast, in the inframammary fold, at 7 o'clock, 13 cm from the\nnipple, there is an oval, mixed hyper and hypoechoic lesion, which connects to\nthe skin. There is some internal vascularity, suggestive of inflammation. No\nnotable posterior features. Overall, these findings likely represent an\ninflamed hair follicle.", + "output": "Oval, mixed hyper and hypoechoic lesion, which connects to the skin and shows\nmild adjacent inflammation likely represents inflamed hair follicle.\n\nRECOMMENDATION(S): 6 week, short interval follow-up is recommended to ensure\nresolution of this finding.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nThere is an oval circumscribed mass in the left upper outer quadrant and\nanterior depth. This is separate from the area of clinical concern which is\nmarked with a BB. There is no dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications in the right breast.\n\nLEFT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned with particular attention given to the 2\no'clock area lower edge at the site of clinical concern indicated by the\nphysician ___ 2 o'clock 4 cm from the nipple at the site of clinical concern\nindicated by the patient. No solid or cystic mass is seen at the sites.\nHowever in the 1 o'clock 4-6 cm from the nipple there is a solid hypoechoic\novoid circumscribed mass which measures 0.7 x 0.3 x 0.7 cm and demonstrates no\ninternal vascularity or posterior features. This corresponds to the mass seen\non the mammogram.", + "output": "No abnormality identified at the site of clinical concern.\nSeparate 7 mm solid mass in the 1 o'clock left breast which could represent a\nfibroadenoma.\n\nRECOMMENDATION: Final disposition of any palpable symptoms should be based on\nclinical grounds.\nA six-month followup with a left breast ultrasound for the mass in the 1\no'clock is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nThere is an oval circumscribed mass in the left upper outer quadrant and\nanterior depth. This is separate from the area of clinical concern which is\nmarked with a BB. There is no dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications in the right breast.\n\nLEFT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned with particular attention given to the 2\no'clock area lower edge at the site of clinical concern indicated by the\nphysician ___ 2 o'clock 4 cm from the nipple at the site of clinical concern\nindicated by the patient. No solid or cystic mass is seen at the sites.\nHowever in the 1 o'clock 4-6 cm from the nipple there is a solid hypoechoic\novoid circumscribed mass which measures 0.7 x 0.3 x 0.7 cm and demonstrates no\ninternal vascularity or posterior features. This corresponds to the mass seen\non the mammogram.", + "output": "No abnormality identified at the site of clinical concern.\nSeparate 7 mm solid mass in the 1 o'clock left breast which could represent a\nfibroadenoma.\n\nRECOMMENDATION: Final disposition of any palpable symptoms should be based on\nclinical grounds.\nA six-month followup with a left breast ultrasound for the mass in the 1\no'clock is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the left breast was performed. In the left breast at 1\no'clock 6 cm from the nipple is a well-circumscribed, oval, hypoechoic mass\nmeasuring 0.8 x 0.3 x 0.7 cm .It shows posterior acoustic enhancement and no\nvascularity. The mass is stable since ___.", + "output": "Stable probable benign solid mass in the left breast likely a fibroadenoma. \nGiven ___ year stability of followup is recommended in ___ year.\n\nRECOMMENDATION(S): ___ year followup ultrasound.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nA circumscribed mass in the upper outer left breast at anterior depth is\nstable. Additionally, a partially circumscribed mass or possibly two adjacent\nmasses in the upper central left breast at posterior depth is noted and was\nfurther evaluated by ultrasound. There is no architectural distortion or\nsuspicious grouped microcalcifications in either breast\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the left breast in\nthe area previously imaged at 1 o'clock 6 cm from the nipple. Again seen is a\n0.8 x 0.3 x 0.8 cm circumscribed, oval hypoechoic mass which is unchanged\nsince ___ and is consistent within a benign process.\n\nTargeted ultrasound was performed in the area of the mammographic abnormality\nin the upper central left breast. At 12 o'clock 4 cm from the nipple there\nare two adjacent circumscribed, oval hypoechoic masses at posterior depth\nmeasuring 1.0 x 0.6 x 0.5 cm and 0.4 x 0.4 x 0.3 cm corresponding to the\nmammographic finding. These are probably benign and likely represent\nfibroadenomas.", + "output": "1. Two year stability of probably benign mass left breast at 1 o'clock and\nnewly identified probably benign masses in the left breast at 12 o'clock. \nSix-month follow-up left breast ultrasound is recommended.\n2. No specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Left breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissues are heterogeneously dense and somewhat\nnodular which lowers the sensitivity of mammography and could conceivably\nobscure a lesion. Bilateral scattered calcifications predominantly layer on\nthe lateral magnified views and are therefore consistent with milk of calcium.\nSeveral small circumscribed mass in the left breast were subsequently\nevaluated with ultrasound and shown to represent cysts. The asymmetry in the\ncentral left breast is stable on mammography since ___ consistent with a\nbenign finding. A nodular asymmetry in the outer left breast is unchanged\nsince ___ consistent with a benign finding. No suspicious mass, area of\narchitectural distortion or cluster of suspicious microcalcifications\nappreciated in either breast.\n\nUltrasound of the left breast at 1 o'clock 6 cm from the nipple in the area of\nconcern on prior imaging demonstrates a stable 0.8 x 0.2 x 0.8 cm mass. Given\nstability for ___ years, this is consistent with a benign finding and no\nfurther imaging followup is necessary at this time.\n\nUltrasound of the left breast at 12 o'clock 3 cm from the nipple in the area\nof concern on prior imaging demonstrated two contiguous simple cysts as\nfollows: 1.3 x 0.5 x 1.1 cm and 0.4 x 0.6 x 0.3 cm. No further imaging\nfollowup is necessary for this finding either.", + "output": "Stable benign mass in the left breast at 1 o'clock and benign cystic changes\nin the left breast at 12 o'clock. Dense breast tissues. No specific\nmammographic evidence of malignancy. The patient may resume routine\nmammographic screening beginning at the age of ___ years.\n\nRECOMMENDATION: Annual mammography beginning at the age of ___ years.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissues are heterogeneously dense and somewhat\nnodular which lowers the sensitivity of mammography and could conceivably\nobscure a lesion. Bilateral scattered calcifications predominantly layer on\nthe lateral magnified views and are therefore consistent with milk of calcium.\nSeveral small circumscribed mass in the left breast were subsequently\nevaluated with ultrasound and shown to represent cysts. The asymmetry in the\ncentral left breast is stable on mammography since ___ consistent with a\nbenign finding. A nodular asymmetry in the outer left breast is unchanged\nsince ___ consistent with a benign finding. No suspicious mass, area of\narchitectural distortion or cluster of suspicious microcalcifications\nappreciated in either breast.\n\nUltrasound of the left breast at 1 o'clock 6 cm from the nipple in the area of\nconcern on prior imaging demonstrates a stable 0.8 x 0.2 x 0.8 cm mass. Given\nstability for ___ years, this is consistent with a benign finding and no\nfurther imaging followup is necessary at this time.\n\nUltrasound of the left breast at 12 o'clock 3 cm from the nipple in the area\nof concern on prior imaging demonstrated two contiguous simple cysts as\nfollows: 1.3 x 0.5 x 1.1 cm and 0.4 x 0.6 x 0.3 cm. No further imaging\nfollowup is necessary for this finding either.", + "output": "Stable benign mass in the left breast at 1 o'clock and benign cystic changes\nin the left breast at 12 o'clock. Dense breast tissues. No specific\nmammographic evidence of malignancy. The patient may resume routine\nmammographic screening beginning at the age of ___ years.\n\nRECOMMENDATION: Annual mammography beginning at the age of ___ years.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Due to the patient's history of stroke and resulting difficulty with\npositioning, her breasts are not completely visualized back to the pectoral\nmuscles and this is a somewhat limited exam.\n\nTissue density: There are scattered areas of fibroglandular density.\nThe ovoid mass in the lower inner quadrant of the left breast is stable in\nappearance. The ovoid mass in the left lateral breast appears smaller and less\ndense compared to prior exam. Bilaterally there are scattered, coarse,\nbenign-appearing calcifications as well as vascular calcifications. There is\nno spiculated mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast.\n\nTargeted ultrasound of the left breast was performed in the areas of clinical\nconcern.\nIn the 3 o'clock position, 4 cm from the nipple there is a 4 x 4 mm anechoic,\nwell-circumscribed mass with no internal vascularity and without significant\nposterior shadowing. Compared to prior exam, this mass has decreased in size\nand is felt to correspond to the mass in the left lateral breast seen on\nmammogram.\nIn the 9 o'clock position, 2 cm from the nipple there is a 9 x 8 x 5 mm\ncircumscribed, predominantly anechoic mass with good through transmission and\nno internal vascularity. This mass is felt to correspond to the mass in the\nlower-inner quadrant of the left breast seen on mammogram and appears stable\nfrom prior exam.\nIn the 8 o'clock position, 2 cm from the nipple there is an 8 x 6 x 4 mm there\nis a septated, predominantly anechoic mass with good through transmission and\nno internal vascularity, all of which is stable from prior exam.", + "output": "Four year stability of left breast simple and septated cysts.\n\nRECOMMENDATION: Annual screening mammography is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient and\nher daughter, and they agree with the plan. The patient was given information\nto schedule her screening mammogram.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Due to limited mobility, a mammogram was deferred at this time.\n\nThe right breast was scanned in its entirety with special attention paid to\nthe area of clinical concern. At ___ o'clock 13 cm from the nipple there is\na 4.3 by 5.3 x 3.5 cm irregular hypoechoic mass with minimal internal\nvascularity. Internal cystic spaces are noted. This correlates well with the\narea of clinical concern. No additional abnormalities are identified in the\nright breast.\n\nThe right axilla was scanned and markedly abnormal lymph nodes were identified\nmeasuring up to 2.1 cm with loss of the fatty hilum.\n\nDue to difficulty with patient positioning, the left breast was not scanned by\nultrasound at this visit.", + "output": "Highly suspicious right breast mass and axillary lymph nodes.\n\nRECOMMENDATION(S): Histologic sampling is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Dr. ___ is already aware of the imaging and clinical findings.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Again seen are two enlarged right axillary lymph nodes, measuring up to 2.6\ncm. In the area of palpable concern in the upper inner right breast there is\nan ill-defined 0.6 x 0.3 x 0.8 cm hypoechoic mass at the 12:00 position,\napproximately 7 cm from the nipple, likely incidental and not accounting for\nthe palpable lump. Although this mass was not targeted for biopsy at this\ntime, it would be amenable to biopsy at a future date, if clinically\nindicated.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\n\nClinicians: ___, NP and ___, MD ___, MD. ___\nprocedure was supervised by ___, M.D.(Attending).\n\nDescription:\n\nAXILLARY LYMPH NODE FNA: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, fine needle aspiration of the abnormal right axillary lymph\nnode was performed. The needle was removed and hemostasis was achieved. A\npost-procedure titanium clip was then placed at the site of the FNA.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided fine needle aspiration. FNA are pending.\n\nThere is an indeterminate mass at 12:00 position 7 cm from the nipple in the\nright breast which was not further evaluated on this exam. The patient has\nnot had a mammogram because she could not tolerate compression following a\nbiopsy of highly suspicious palpable mass in the right breast performed at the\nclinician's office today. The patient will return for a diagnostic mammogram\nand ultrasound later this week. Alternatively, an MRI could be obtained for\nfurther characterization of extent of disease if clinically indicated.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation.\nTechnically successful US-guided FNA of the right axillary lymph node." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 66 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 79, 37, and 39 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 78 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 33, 39, and 35 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 14 cm/sec.\nThe ICA/CCA ratio is 0.5.\nThe external carotid artery has peak systolic velocity of 116 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nPreviously seen mass in the upper outer right breast has markedly decreased in\nsize. It currently measures 3.3 x 4.9 by 3.8 cm, having previously measured\n6.5 x 6.0 by 5.4 cm\n\nBREAST ULTRASOUND: At ___ o'clock 13 cm from the nipple there is\nre-demonstration of a spiculated suspicious mass. Currently measures 2.7 x\n3.6 x 1.8 cm. It abuts the skin surface. It is far smaller then prior\nimaging, at which time it measured at least 5.3 x 3.5 by 4.3 cm.\n\nThe right axilla was scanned and the previously seen markedly abnormal lymph\nnodes are no longer clearly seen. The lymph node containing a percutaneous\nbiopsy clip is found and far smaller.", + "output": "Decrease in size of previously noted right breast mass and axillary lymph\nnodes.\n\nRECOMMENDATION(S): Per clinical team\n\nNOTIFICATION: Findings and recommendations reviewed with the patient and her\ndaughter at the completion of the study.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nPreviously seen mass in the upper outer right breast has markedly decreased in\nsize. It currently measures 3.3 x 4.9 by 3.8 cm, having previously measured\n6.5 x 6.0 by 5.4 cm\n\nBREAST ULTRASOUND: At ___ o'clock 13 cm from the nipple there is\nre-demonstration of a spiculated suspicious mass. Currently measures 2.7 x\n3.6 x 1.8 cm. It abuts the skin surface. It is far smaller then prior\nimaging, at which time it measured at least 5.3 x 3.5 by 4.3 cm.\n\nThe right axilla was scanned and the previously seen markedly abnormal lymph\nnodes are no longer clearly seen. The lymph node containing a percutaneous\nbiopsy clip is found and far smaller.", + "output": "Decrease in size of previously noted right breast mass and axillary lymph\nnodes.\n\nRECOMMENDATION(S): Per clinical team\n\nNOTIFICATION: Findings and recommendations reviewed with the patient and her\ndaughter at the completion of the study.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "A large complex fluid collection in the right upper outer breast surgical bed\nis difficult to definitively measure but spans approximately 6.9 x 5.2 x 7.2\ncm.", + "output": "Large complex fluid collection in the right upper outer breast in the surgical\nbed may represent hematoma, abscess, or seroma with debris." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Bilateral nipple jewelry is noted.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of clinical\nconcern. At 11 o'clock, 0-10 cm from the nipple, there was no suspicious\ndiscrete solid or cystic mass to correlate with the palpable finding.", + "output": "1. No mammographic or sonographic correlate to the area of palpable concern\nin the right breast.\n\n2. No evidence of malignancy.\n\nRECOMMENDATION: Further management for the area of clinical concern in the\nright breast should be based on the clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Bilateral nipple jewelry is noted.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of clinical\nconcern. At 11 o'clock, 0-10 cm from the nipple, there was no suspicious\ndiscrete solid or cystic mass to correlate with the palpable finding.", + "output": "1. No mammographic or sonographic correlate to the area of palpable concern\nin the right breast.\n\n2. No evidence of malignancy.\n\nRECOMMENDATION: Further management for the area of clinical concern in the\nright breast should be based on the clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAgain seen is an at least 3.1 x 2.4 cm area of architectural distortion within\nthe superior left breast. Otherwise, there is no suspicious grouped\nmicrocalcifications within the left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. No definitive stellate\nappearing suspicious mass or area of architectural distortion is definitively\nconfirmed within the left breast when scanning from the 1:00 to 4:00 position\nof the left breast approximately 10 cm from the nipple. Additional evaluation\nof the left axilla demonstrates normal appearing lymph nodes.", + "output": "At least 3.1 x 2.4 cm area of architectural distortion within the superior\nleft breast. This is highly suspicious for malignancy and 3D mammography\nguided core needle biopsy is recommended for further evaluation.\n\nRECOMMENDATION(S): 3D mammography guided core needle biopsy of the left\nbreast. The patient will return on ___ at 12:40 for the biopsy.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 16:45 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nIn the left lateral, slightly superior breast, in the area of clinical\nconcern, there is a partially circumscribed subcentimeter mass. In the\nposterior left breast on the MLO view there is an asymmetry that is pliable on\nML views without a correlate on the CC view consistent with breast tissue. An\nasymmetry in the outer breast on the CC view appeared to contain\ncalcifications, however, magnification views confirmed that this was normal\nbreast tissue with benign round scattered calcifications. No additional areas\nof concern are seen.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast at the 3\no'clock position approximately 4 to 5 cm from the nipple in the area of\nclinical concern, there is a predominantly hypoechoic mass with irregular\nborders, measuring 0.8 x 0.7 x 0.7 cm with some internal vascularity. In the\nleft axilla, normal appearing lymph nodes are visualized.", + "output": "Suspicious mass in the left breast at 3 o'clock 4-5 cm from the nipple in the\narea of clinical concern.\n\nRECOMMENDATION: Ultrasound-guided core biopsy is recommended.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy, which has been scheduled for ___ addition, the patient\njust began to take coumadin for newly diagnosed atrial fibrillation. She will\ndiscuss coumadin management prior to the procedure with her cardiologist and\nwill get a preprocedure INR checked.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "In the left breast, at the 3 o'clock position, 4 cm from the nipple is a 6 x 7\nx 5 mm hypoechoic mass with irregular borders.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, radiology resident and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement, in the central slightly outer left breast. The asymmetry in the\nupper left breast is again seen and for this reason a repeat ultrasound was\nperformed of the upper outer left breast. No ultrasound correlate was found.", + "output": "1. Technically successful US-guided core biopsy of the breast lesion. \nPathology is pending. The patient expects to hear the pathology results from\nDr. ___ in ___ business days. Standard post care instructions were\nprovided to the patient.\n\n2. Left breast asymmetry in the upper probably outer left breast is\nredemonstrated on today's exam and has no ultrasound correlate. Further\nmanagement, including consideration for stereotactic core biopsy, will be\nbased on the pathology results." + }, + { + "input": "In the left breast, at the 3 o'clock position, 4 cm from the nipple is a 6 x 7\nx 5 mm hypoechoic mass with irregular borders.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, radiology resident and ___, M.D.. The\nprocedure was supervised by ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement, in the central slightly outer left breast. The asymmetry in the\nupper left breast is again seen and for this reason a repeat ultrasound was\nperformed of the upper outer left breast. No ultrasound correlate was found.", + "output": "1. Technically successful US-guided core biopsy of the breast lesion. \nPathology is pending. The patient expects to hear the pathology results from\nDr. ___ in ___ business days. Standard post care instructions were\nprovided to the patient.\n\n2. Left breast asymmetry in the upper probably outer left breast is\nredemonstrated on today's exam and has no ultrasound correlate. Further\nmanagement, including consideration for stereotactic core biopsy, will be\nbased on the pathology results." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nUnderlying metallic BB in the medial right breast, there are 2 adjacent\nspiculated masses measuring 3.7 cm in total extent. There are pleomorphic\ncalcifications associated with the anterior mass. Additional round and\nlayering benign-appearing calcifications are identified in the upper-outer\nright breast. There are grouped amorphous and heterogeneous in the\nupper-outer left breast. There is no additional suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcification.\n\nBREAST ULTRASOUND: US FINDING\n\nIn the area of clinical concern, at the 2 o'clock position of the right breast\n3-7 cm from the nipple, there are 2 adjacent irregular hypoechoic masses with\nindistinct margins and posterior shadowing measuring 2.4 x 2.3 x 1.8 cm and\n1.1 x 0.9 x 1.3 cm. The anterior mass is dominant however there is apparent\ncontiguous extension between the 2 masses. This corresponds to the suspicious\nmammographic masses.\n\nAt the 10 o'clock position of the right breast 7 cm from the nipple, there is\na superficial 7 x 7 x 5 mm hypoechoic mass.\n\nNormal appearing lymph nodes are present in the right axilla without evidence\nof irregularity or cortical thickening.", + "output": "Dominant right breast mass at the 2 o'clock position (conglomerate of 2\ncontiguous adjacent masses), corresponding to the area of clinical concern, is\nhighly suspicious for malignancy. Ultrasound-guided core biopsy is\nrecommended.\n\nSecond right breast mass at 10 o'clock position is indeterminate. While the\nappearance of this mass differs from the dominant mass, ultrasound-guided\nbiopsy is recommended to exclude satellite lesion.\n\nNo evidence of suspicious right axillary lymphadenopathy.\n\nLeft breast microcalcifications are suspicious. Stereotactic core biopsy is\nrecommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsies of the right breast mass\nat 2 o'clock position and right breast mass at 10 o'clock position. \nStereotactic core biopsy of the left breast microcalcifications. The patient\nagreed to participate in research breast MRI prior to ultrasound core\nbiopsies.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She met with breast imaging coordinator to schedule the\nbiopsies and research MRI. Findings and recommendations were emailed to Dr.\n___ Dr. ___ ___ at 16:30.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "In the right breast, at 2 o'clock, 3-7 cm from the nipple, there is a 2.3 x\n1.3 x 3.0 cm irregular, hypoechoic mass that is a target for core biopsy.\nIn the right breast, at 10 o'clock, 7 cm from the nipple, there is a 0.6 x 0.4\nx 0.6 cm oval hypoechoic mass that is the second target for core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P, ___, M.D., ___, M.D.. The procedure\nwas supervised by ___, M.D. (Attending).\n\nDescription:\nFor the right breast mass at 2 o'clock:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the lesion and 6 cores were obtained\nusing a 14-gauge Bard spring-loaded biopsy device. Next, a percutaneous\nribbon clip was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\nFor the right breast mass at 10 o'clock:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the lesion and 5 cores were obtained\nusing a 14-gauge Bard spring-loaded biopsy device. Next, a percutaneous\nHydroMark coil was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\n\nEstimated blood loss: < 5 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof the ribbon clip and the HydroMark coil.", + "output": "Technically successful US-guided core biopsy of the two right breast masses. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast, at 2 o'clock, 3-7 cm from the nipple, there is a 2.3 x\n1.3 x 3.0 cm irregular, hypoechoic mass that is a target for core biopsy.\nIn the right breast, at 10 o'clock, 7 cm from the nipple, there is a 0.6 x 0.4\nx 0.6 cm oval hypoechoic mass that is the second target for core biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P, ___, M.D., ___, M.D.. The procedure\nwas supervised by ___, M.D. (Attending).\n\nDescription:\nFor the right breast mass at 2 o'clock:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the lesion and 6 cores were obtained\nusing a 14-gauge Bard spring-loaded biopsy device. Next, a percutaneous\nribbon clip was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\nFor the right breast mass at 10 o'clock:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle was placed adjacent to the lesion and 5 cores were obtained\nusing a 14-gauge Bard spring-loaded biopsy device. Next, a percutaneous\nHydroMark coil was deployed under ultrasound guidance. The needle was removed\nand hemostasis was achieved.\n\n\nEstimated blood loss: < 5 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof the ribbon clip and the HydroMark coil.", + "output": "Technically successful US-guided core biopsy of the two right breast masses. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 54 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 75, 54, and 77 Cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 116 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 56. Cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 45, 39, and 62 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.1..\nThe external carotid artery has peak systolic velocity of 89 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild atherosclerotic plaque with bilateral ___ ICA stenosis. Antegrade\nvertebral flow." + }, + { + "input": "RIGHT:\nThere is no atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 46.8 cm/s / 7.86 cm/s\nCCA Distal: 62.5 cm/s / 9.04 cm/s\nICA ___: 57.4 cm/s / 12.2 cm/s\nICA Mid: 54.2 cm/s / 13.8 cm/s\nICA Distal: 75.8 cm/s / 19.6 cm/s\nECA: 55.7 cm/s\nVertebral: 60.5 cm/s\n\nICA/CCA Ratio: 1.21\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is no atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 75.6 cm/s / 17.6 cm/s\nCCA Distal: 61.6 cm/s / 14.7 cm/s\nICA ___: 61.8 cm/s / 15.5 cm/s\nICA Mid: 30.1 cm/s / 9.36 cm/s\nICA Distal: 58.5 cm/s / 18 cm/s\nECA: 43.1 cm/s\nVertebral: 46.9 cm/s\n\n\nICA/CCA Ratio: 1\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous calcified atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 40 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 52, 15, and 59 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 13 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 147 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous calcified atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 49 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 38, 52, and 42 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 149 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous atherosclerotic plaque of the bilateral extracranial\ninternal carotid arteries without significant stenosis (less than 40%)." + }, + { + "input": "The outer aspect of both breasts were evaluated in normal breast tissue is\nseen. No dominant mass was noted.", + "output": "Normal breast tissue identified in the areas of clinical concern in both outer\nbreasts.\n\nRECOMMENDATION(S): Clinical followup is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Targeted ultrasound was performed in the area of pain from ___ o'clock 1-7 cm\nfrom the nipple. Normal breast tissue is identified without any suspicious\nsolid or cystic mass.", + "output": "No suspicious findings in the left breast in the area of pain. Clinical\nfollow-up is recommended\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThere is moderate heterogenous atherosclerotic plaque in the right carotid\nartery and proximal right internal carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 91.5 cm/s / 16.4 cm/s\nCCA Distal: 74.5 cm/s / 18.8 cm/s\nICA ___: 116 cm/s / 28.5 cm/s\nICA Mid: 107 cm/s / 20.6 cm/s\nICA Distal: 90.4 cm/s / 23.6 cm/s\nECA: 88.4 cm/s\nVertebral: 75.6 cm/s\n\nICA/CCA Ratio: 1.56\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 106 cm/s / 10.8 cm/s\nCCA Distal: 115 cm/s / 19.6 cm/s\nICA ___: 103 cm/s / ___.6 cm/s\nICA Mid: 77.6 cm/s / 19.6 cm/s\nICA Distal: 94.3 cm/s / 24.6 cm/s\nECA: 56.4 cm/s\nVertebral: 49.1 cm/s\n\nICA/CCA Ratio: 0.9\n\nThe left vertebral artery flow is retrograde.", + "output": "Right ICA 40-59% stenosis.\nLeft ICA <40% stenosis. Retrograde flow in the left vertebral artery which\ncan be seen in left subclavian steal." + }, + { + "input": "The transplant pancreas graft is seen in the right lower quadrant. \nVisualization is somewhat limited by adjacent bandaging, but the echogenicity\nof the transplant appears uniform. No peritransplant fluid collections are\nseen. Vascularity is symmetric throughout the gland with normal arterial\nwaveforms and resistive indices ranging from 0.63-0.72. Acceleration time of\nthe arterial waveforms is normal with peak velocity 139 centimeters/second. \nNormal venous Doppler waveforms were also obtained.", + "output": "Slightly limited views but otherwise normal appearance of the right lower\nquadrant pancreatic transplant." + }, + { + "input": "There is normal respiratory variation in both common femoral veins. There is\nnormal compressibility and augmentation of both common femoral, superficial\nfemoral, popliteal, posterior tibial, and peroneal veins.", + "output": "No evidence of deep vein thrombosis in either lower extremity." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 70 C cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 41, 47, and 63 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 24\ncm/sec.\nThe ICA/CCA ratio is 0.82..\nThe external carotid artery has peak systolic velocity of 52 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 31, 33, and 36 Cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 13\ncm/sec.\nThe ICA/CCA ratio is 0.49.\nThe external carotid artery has peak systolic velocity of 62 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA no stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n67/22 cm/sec in its proximal portion, 34/16 cm/sec in its mid portion, and\n77/29 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n56/20 cm/sec.\nThe external carotid artery has peak systolic velocity of 85 cm/sec.\nThe vertebral artery has peak systolic velocity of 49 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.2.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n56/26 cm/sec in its proximal portion, 61/25 cm/sec in its mid portion, and\n47/18 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 62/21\ncm/sec.\nThe external carotid artery has peak systolic velocity of 68 cm/sec.\nThe vertebral artery has peak systolic velocity of 38 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.98.", + "output": "There is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "RIGHT:\nThere is moderate heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 85.1 cm/s / 21.1 cm/s\nCCA Distal: 68.6 cm/s / 20 cm/s\nICA ___: 129 cm/s / 33.1 cm/s\nICA Mid: 97.9 cm/s / 27.1 cm/s\nICA Distal: 102 cm/s / 31 cm/s\nECA: 418 cm/s\nVertebral: 27.8 cm/s\n\nICA/CCA Ratio: 1.88\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left common\ncarotid artery and bulb.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 74.2 cm/s / 13.1 cm/s\nCCA Mid ___ cm/s / 28 cm/s\nCCA Distal: 169 cm/s / 23.3 cm/s\nBulb 180 cm/s / 39 cm/s\nICA ___: 75.9 cm/s / 17 cm/s\nICA Mid: 67.8 cm/s / 14 cm/s\nICA Distal: 41.5 cm/s / 19.6 cm/s\nECA: 132 cm/s\nVertebral: 60.2 cm/s\n\nICA/CCA Ratio: 0.45\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 40-59% stenosis. Significant Right ECA stenosis.\nLeft Carotid bulb stenosis 60-69%." + }, + { + "input": "Targeted ultrasound right breast was performed over the palpable areas\nindicated by the patient. In the right breast between ___ o'clock 4 cm from\nthe nipple is dense tissue with small sub 5 mm cysts. There is no discrete\nsolid mass.", + "output": "Dense breast with few sub 5 mm cysts in the right breast underlying palpable\narea, consistent with fibrocystic change.\n\nRECOMMENDATION(S): Final disposition should be based on clinical evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is noatherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 117 cm/s / 29.8 cm/s\nCCA Distal: 80.7 cm/s / 23 cm/s\nICA ___: 62.2 cm/s / 16.7 cm/s\nICA Mid: 64.6 cm/s / 22.2 cm/s\nICA Distal: 75 cm/s / 24.3 cm/s\nECA: 94.4 cm/s\nVertebral: 57.8 cm/s\n\nICA/CCA Ratio: 0.93\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is no atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 78.3 cm/s / 11.8 cm/s\nCCA Distal: 91.3 cm/s / 23.6 cm/s\nICA ___: 90.4 cm/s / 29.4 cm/s\nICA Mid: 70.7 cm/s / 25.1 cm/s\nICA Distal: 89.9 cm/s / 31.7 cm/s\nECA: 81.3 cm/s\nVertebral: 49.9 cm/s\n\nICA/CCA Ratio: 0.99\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.\n\nNo hematoma seen.", + "output": "Right ICA no stenosis.\nLeft ICA no stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has a moderately large, elevated soft\natherosclerotic plaque. Within the plaque deep to the endothelium, there is\narterial blood flow suggestive of a possible partial dissection into the\nplaque.\nThe peak systolic velocity in the right common carotid artery is 59 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 96 cm/s, 103 cm/s, and 56 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of59 cm/s.\nThe vertebral artery is patent with antegrade flow and normal pulse Doppler\nwaveform..\n\nLEFT:\nThe left carotid vasculature has mild calcified atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 52 cm/s, 76 cm/s, and 72 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 46 cm/s.\nThe left vertebral artery could not be identified despite extensive effort.", + "output": "No hemodynamically significant stenosis.\n\nHowever the left internal carotid has a large soft elevated plaque and within\nthe plaque there is arterial flow suggesting possible dissection into the\nplaque creating a vulnerable plaque situation.\n\nNOTIFICATION: The findings of the elevated soft plaque with undermined blood\nflow were related to ___ by Dr. ___ telephone at 16:24, 10 minutes\nafter the scan was completed." + }, + { + "input": "A limited renal ultrasound was performed for the procedure, demonstrating no\nhydronephrosis. Renal cysts are seen once again, largest measuring 4.3 cm in\nthe lower pole of the right kidney.\n\nThis procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 3 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 50\nmcg fentanyl and 1 mg versed throughout the total intra-service time of 20\nminutes during which the patient's hemodynamic parameters were continuously\nmonitored by an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 100 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 79, 94, and 47 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 109 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 76, 123, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "There is less than 40% stenosis within the internal carotid arteries\nbilaterally." + }, + { + "input": "There is normal respiratory variation in both common femoral veins.\nThere is normal compressibility and augmentation of the right common femoral,\nsuperficial femoral, popliteal, and posterior tibial veins. The peroneal\nveins were not visualized. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis in the right lower extremity veins. The\nperoneal veins are not visualized." + }, + { + "input": "Ultrasound of the right axilla, approximately 14 cm from the nipple,\ndemonstrated a well-circumscribed 0.4 cm hypoechoic structure in the dermis,\ncorresponding to the patient's resolving pimple. There are no suspicious\nmasses seen.", + "output": "Dermal hypoechoic structure corresponding to resolving skin lesion.\n\nRECOMMENDATION: Final disposition of patient's symptoms should be based on\nclinical grounds. Otherwise age and risk appropriate screening is\nrecommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "The aorta measures 2.7 cm in the proximal portion, 1.8 cm in mid portion and\n1.9 cm in the distal abdominal aorta. There are mild calcified\natherosclerotic plaque.\n\nWall-to-wall color flow is seen within aorta.\n\nThe common iliac vessels were not measured.\n\nThe right kidney measures 12.6 cm and the left kidney measures 12.4 cm.\nLimited views of the kidneys show no hydronephrosis. Nonobstructing stones\nare seen in the right kidney. Bilateral renal cysts are noted.\n\nGallstones are noted within the gallbladder.", + "output": "No evidence of abdominal aortic aneurysm.\n\nNonobstructing right renal stones.\n\nCholelithiasis." + }, + { + "input": "There is no appreciable plaque or wall thickening involving either carotid\nsystem. The peak systolic velocities as well as the ICA to CCA ratios are\nnormal bilaterally. There is normal antegrade flow involving both vertebral\narteries.", + "output": "Normal duplex and color Doppler assessment of both carotid systems." + }, + { + "input": "RIGHT:\nThere is moderate heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 51.9 cm/s / 12.2 cm/s\nCCA Distal: 63.3 cm/s / 21.2 cm/s\nICA ___: 63.3 cm/s / 28.3 cm/s\nICA Mid: 82.7 cm/s / 32.8 cm/s\nICA Distal: 62.2 cm/s / 25.4 cm/s\nECA: 117 cm/s\nVertebral: 33.6 cm/s\n\nICA/CCA Ratio: 1.31\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 51.9 cm/s / 15.3 cm/s\nCCA Distal: 34.3 cm/s / 11.9 cm/s\nICA ___: 58 cm/s / 17 cm/s\nICA Mid: 92 cm/s / 26.4 cm/s\nICA Distal: 92.8 cm/s / 35.2 cm/s\nECA: 112 cm/s\nVertebral: 12.9 cm/s\n\nICA/CCA Ratio: 2.71\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA 50-69% stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 5 L of yellow-brown fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Transverse and sagittal images were obtained without and with Valsalva.\n\nThe images were equivocal for right inguinal hernia.", + "output": "Images were equivocal for a right inguinal hernia. Patient should return for\nfurther imaging for evaluation and completion of the study at no additional\ncharge with attention to Dr ___.\n\nNOTIFICATION: The findings were discussed with ___, R.N. by ___\n___, M.D. on the telephone on ___ at 11:34 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 75, 83, and 70 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 27\ncm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has minimal heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 69, 69, and 52 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 27\ncm/sec.\nThe ICA/CCA ratio is 0.82.\nThe external carotid artery has peak systolic velocity of 59 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Targeted right breast ultrasound was performed.\n\nIn the area of palpable abnormality, in the right breast, at ___ o'clock, 0-1\ncm from the nipple, dense breast tissue is noted without suspicious solid or\ncystic mass.", + "output": "Normal targeted ultrasound.\n\nRECOMMENDATION(S): Clinical follow-up for any persistent clinical findings. \nAge and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Successful ultrasound-guided drainage of the previously identified lumbar\ncollections. Separate samples sent for culture.", + "output": "Successful ultrasound-guided lumbar fluid collection drainage x 2. Cultures\npending." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 51 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 81, 118, and 80 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 2.3.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 75 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 65, 83, and 79 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.1..\nThe external carotid artery has peak systolic velocity of 100 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral ___ ICA stenosis, mild plaque. Antegrade vertebral flow." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBILATERAL BREAST ULTRASOUND: The upper outer quadrant of both breasts were\nevaluated in the areas of clinical concern as directed by the patient. No\nabnormalities were identified.", + "output": "No evidence for malignancy in either breast.\n\nRECOMMENDATION(S): Clinical follow-up for bilateral breast pain. Age and\nrisk appropriate screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\n There is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper outer and lower outer central quadrant and right axilla was scanned.\nIn the 9 o'clock 3 cm from the nipple there is a solid hypoechoic ill-defined\nmass with angular margins and increased vascularity. This measures 3.3 x 1.4\nx 2.2 cm. This corresponds to the patient's tender palpable mass. Ultrasound\nof the right axilla demonstrates an abnormally enlarged right axillary lymph\nnode with no definite hilum. The cortex measures 5 mm.", + "output": "Solid ill-defined mass in the 9 o'clock right breast palpable to the patient\nwith features that are indeterminate for malignancy. Enlarged right axillary\nlymph node.\n\nRECOMMENDATION: Ultrasound-guided core biopsy of right breast mass and fine\nneedle aspiration of right axillary lymph node is recommended. Both\nprocedures will be performed on ___.\n\nNOTIFICATION: Findings and recommendations were discussed in detail with the\npatient at the conclusion examination. Findings and recommendations were\ncommunicated to Dr. ___ Dr. ___ email at 10:30 on ___.\n\n\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\n There is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper outer and lower outer central quadrant and right axilla was scanned.\nIn the 9 o'clock 3 cm from the nipple there is a solid hypoechoic ill-defined\nmass with angular margins and increased vascularity. This measures 3.3 x 1.4\nx 2.2 cm. This corresponds to the patient's tender palpable mass. Ultrasound\nof the right axilla demonstrates an abnormally enlarged right axillary lymph\nnode with no definite hilum. The cortex measures 5 mm.", + "output": "Solid ill-defined mass in the 9 o'clock right breast palpable to the patient\nwith features that are indeterminate for malignancy. Enlarged right axillary\nlymph node.\n\nRECOMMENDATION: Ultrasound-guided core biopsy of right breast mass and fine\nneedle aspiration of right axillary lymph node is recommended. Both\nprocedures will be performed on ___.\n\nNOTIFICATION: Findings and recommendations were discussed in detail with the\npatient at the conclusion examination. Findings and recommendations were\ncommunicated to Dr. ___ Dr. ___ email at 10:30 on ___.\n\n\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Right breast mass 9 o'clock 3 cm from the nipple and in enlarged right\naxillary lymph node are reidentified\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by P. ___,\nM.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nAttention was then directed to the axilla. Using standard aseptic technique\nand 1% lidocaine for local anesthesia 3 passes were made with 25 gauge\nneedles. The specimen was placed in CytoLyte and sent to cytology. The needle\nwas removed ahd hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and Cytology, respectively\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. No signficant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast mass at 9:00.\nPathology is pending. Aspirates from the right axillary node were sent to\ncytology and also is pending. The patient expects to hear the pathology\nresults from Dr. ___ or Dr. ___ in ___ business days.\nStandard post care instructions were provided to the patient." + }, + { + "input": "Right breast mass 9 o'clock 3 cm from the nipple and in enlarged right\naxillary lymph node are reidentified\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by P. ___,\nM.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, multiple cores were\nobtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nAttention was then directed to the axilla. Using standard aseptic technique\nand 1% lidocaine for local anesthesia 3 passes were made with 25 gauge\nneedles. The specimen was placed in CytoLyte and sent to cytology. The needle\nwas removed ahd hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and Cytology, respectively\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. No signficant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast mass at 9:00.\nPathology is pending. Aspirates from the right axillary node were sent to\ncytology and also is pending. The patient expects to hear the pathology\nresults from Dr. ___ or Dr. ___ in ___ business days.\nStandard post care instructions were provided to the patient." + }, + { + "input": "Right lower quadrant abscess, containing purulent material. Successful ___\npigtail catheter placement. Microbiology analysis pending.", + "output": "Successful US-guided placement of ___ pigtail catheter into right mid\nabdominal collection. Samples was sent for microbiology evaluation." + }, + { + "input": "RIGHT:\nThere is severe heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 80.1 cm/s / 18.6 cm/s\nCCA Distal: 74.4 cm/s / 16 cm/s\nICA ___: 283 cm/s / 69.2 cm/s\nICA Mid: 120 cm/s / 40.2 cm/s\nICA Distal: 105 cm/s / 29.2 cm/s with delayed upstroke\nECA: 216 cm/s\nVertebral: 113 cm/s\n\nICA/CCA Ratio: 3.8\n\nThe right vertebral artery flow is antegrade with a delayed upstroke.\nThe right subclavian artery is triphasic.\n\n\nLEFT:\nThere is severe homogenous atherosclerotic plaque in a 1.6 cm segment of the\nproximal Internal Carotid Artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 109 cm/s / 13.2 cm/s\nCCA Distal: 71.3 cm/s / 14.8 cm/s\nICA ___: 323 cm/s / 120 cm/s\nICA Mid: 182 cm/s / 53.3 cm/s\nICA Distal: 72.7 cm/s / 12 cm/s\nECA: 245 cm/s\nVertebral: 38.4 cm/s\n\nICA/CCA Ratio: 4.53\n\nThe left vertebral artery flow is with systolic retrograde flow consistent\nwith with a grade 2/incomplete subclavian steal spectral waveform.\nThe left subclavian artery is monophasic with delayed upstroke throughout with\nno stenosis identified (likely proximal to adequate imaging available\nultrasound).", + "output": "Right ICA 70-79% stenosis.\nLeft ICA 80-99% stenosis.\nRetrograde systolic left vertebral artery flow with grade 2/incomplete\nsubclavian artery steal and subclavian artery waveforms suggestive of a more\nproximal stenosis, which could not be visualized.\nDelayed upstroke in the right vertebral artery which can be suggestive of a\nmore proximal stenosis which was not visualized.\n\nCompared to ___, degree of carotid stenosis significantly increased\nbilaterally. Left vertebral artery waveform is similar." + }, + { + "input": "X per CT prior to procedure: Newly placed right frontal EVD terminates in the\nright lateral ventricle. There is no evidence of hemorrhage along the tract.\nSmall amount of pneumocephalus adjacent to the burr hole for the EVD. Again\nnoted subarachnoid hemorrhage. And intraparenchymal hemorrhage primarily in\nthe left frontal lobe surrounded by hypodensity concerning for ischemic stroke\nversus edema.\n\n Ultrasound the right common femoral artery: There is a single\nnoncompressible, arterial, pulsatile lumen. There is evidence of access of\nthe wire into the lumen. Images were saved to the patient's permanent medical\nrecord.\n\nLeft internal carotid artery: There is no evidence of carotid stenosis\ncervical region based on roadmap images and NASCET criteria. There is\nopacification the anterior and middle cerebral arteries and their distal\nterritories. There is cross-filling across the anterior communicating artery\nand filling of the contralateral A 2 segment. There is an area of extreme\nvasospasm at the origin of the right A 2 segment that is consistent with a\nstring sign. There is an aneurysm approximately 4.5 mm that arises from the\nanterior communicating artery. It is try lobe. And extends with different\nlobes off opposite side of the anterior communicating artery. This anatomy is\nconfirmed on the three-dimensional rotational imaging. The origin of the left\nartery of heubner is associated with the neck of the aneurysm.\n\nLeft internal carotid artery after balloon assisted coil placement: The\nanterior lobe the aneurysm has coils in place. The additional lobe appears\nlarger in size. There is no active extravasation. There is no vessel\ndropout. The Vasa spasm persists in the right A2: There is a new small bleb\nadjacent to the left A2 origin that may represent pseudoaneurysm.\n\nLeft internal carotid artery after partial coiling: There is active\nextravasation noted.\n\nLeft internal carotid artery after coiling completion: There is no residual\nfilling of the previously identified anterior communicating artery aneurysm. \nThere are coils within the anterior communicating artery but there is\npersistent filling the bilateral A2 segments. The right A2 continues to have\nspasm at the origin. There is good opacification distal. The filling is\nsomewhat slowed compared to previously specifically on the left A 2. But\nthere is filling. Three-dimensional rotational imaging confirms no residual\nfilling of the previously identified aneurysm with no active extravasation and\ncoil in the parent artery.\n\nRight common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.\n\nX per head CT post procedure: Again noted subarachnoid hemorrhage. There is\ncoil artifact at the anterior communicating artery. There is increase in\ninterventricular hemorrhage. There is new hemorrhage layering on the\ntentorium. There is increase in the intraparenchymal component with contrast\npresent in the left frontal lobe. External ventricular drain continues to\ntraverse and terminate in the right lateral ventricle.", + "output": "Balloon assisted coiling of the ruptured anterior communicating artery\naneurysm complicated by intraprocedural rupture. Coils do fill the parent\nartery. ___ 1.\n\nRECOMMENDATION(S):\n1. Start aspirin 325 mg and keep blood pressure above 130 in light of coils in\nthe parent artery." + }, + { + "input": "BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM:\n\n There are scattered areas of fibroglandular density.\n\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: The left breast was scanned in the area of pain from\n___ o'clock. No solid or cystic mass is detected.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION: Routine annual mammography starting at age ___. The patient's\nbreast pain should be managed clinically.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 44, 52, and 60 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 12 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 64 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 65 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 42, 50, and 45 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 13 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 36 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild heterogeneous calcified plaque within the internal carotid arteries with\nless than 40% stenosis of each carotid artery." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.3 L of clear, yellow fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.3 L of clear, yellow fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.2 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.2 L of fluid were removed." + }, + { + "input": "LMP: The patient is status post hysterectomy.\n\nTissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRIGHT BREAST:\nBackground parenchymal enhancement: Moderate.\n\nThere is no suspicious mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications on the low energy images. There is no\nsuspicious enhancement on the recombined images.\n\nLEFT BREAST:\nBackground parenchymal enhancement: Moderate.\n\nThere is a 1.4 cm oval, non-enhancing circumscribed isodense mass in the\nmedial, superior left breast. This mass was further evaluated on same day\nultrasound. In addition, slightly posterior to this there is a stable 0.8 cm\nasymmetry which may represent a hamartoma but is compatible with a benign\nentity given stability dating back to ___. There is no unexplained\narchitectural distortion or suspicious grouped microcalcifications on low\nenergy images. There is no suspicious enhancement on the recombined images.\n\nUltrasound of the left breast was performed from ___, 1-8 cm from the\nnipple corresponding the area of concern on mammography. A few scattered\nsimple cysts were seen with the largest at 11:00, 5 cm from the nipple\nmeasuring 1.4 x 0.7 x 0.9 mm which is felt to likely correspond to the\nmammographic finding on the prior study ___. No solid suspicious\nmass is seen. Therefore, the patient may resume routine mammographic\nscreening.", + "output": "1.4 cm simple cyst in the left breast at 11 o'clock likely corresponding to\nthe mammographic finding seen on the screening study dated ___. \nModerate background enhancement with no suspicious enhancement in either\nbreast on the contrast enhanced study.\n\nRECOMMENDATION(S): Annual screening mammography. Clinical follow-up.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 3 L of clear, amber fluid were removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the right hemithorax demonstrated a\nlarge amount of pleural fluid. A suitable target in the deepest pocket in the\nright posterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine buffered with\nsodium bicarbonate was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nposterior mid scapular line and 0.5 L of clear, amber fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential,\nculture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic right\nthoracentesis" + }, + { + "input": "Limited grayscale ultrasound imaging of the left hemithorax demonstrated a\nlarge amount of pleural fluid. A suitable target in the deepest pocket in the\nleft posterior mid scapular line was selected for thoracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine buffered with\nsodium bicarbonate was instilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nposterior mid scapular line and 1.25 L of red serous amber fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "Technically successful ultrasound-guided therapeutic LEFT thoracentesis." + }, + { + "input": "Abnormal right inguinal lymph node as above.", + "output": "Technically successful ultrasound-guided right inguinal node biopsy. Samples\nwere sent according to the lymphoma protocol." + }, + { + "input": "In the left breast at 1:00 position 1 cm from the nipple there is a 3.1 x 2.6\nx 1.6 cm complex fluid collection. In the right subareolar breast no\nsuspicious cystic or solid mass is seen.", + "output": "There is a complex fluid collection underneath the left nipple. \nUltrasound-guided aspiration was recommended to the patient, however the\npatient refused.\n\nNo suspicious cystic or solid mass and beneath the right nipple on ultrasound.\n\nRECOMMENDATION(S): Aspiration of complex fluid collection underneath the left\nnipple. Clinical follow-up of the right breast.\n\nNOTIFICATION: Findings reviewed with the patient and with ___,\nNP at the completion of the study. She will follow up with the patient.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the right breast was performed in the retroareolar\nregion. Immediately deep to the skin, there is an irregular hypoechoic\navascular collection with a thick rim measuring approximately 3.1 x 3.2 x 2.6\ncm, compatible with an abscess. The collection is filled with debris. There\nis also a moderate amount of skin thickening, as well as surrounding\nsubcutaneous edema. No other abnormalities are visualized within the right\nretroareolar region.", + "output": "3.2 cm irregular hypoechoic avascular collection with a thick rim within the\nretroareolar region of the right breast at the area of skin redness and\nswelling, compatible with an abscess." + }, + { + "input": "RIGHT BREAST:\nTargeted ultrasound of the right breast in the area of clinical concern at 4\no'clock, 0-3 cm from the nipple demonstrates a heterogeneously hypoechoic\nfluid collection measuring 1.2 x 0.6 x 0.6 cm, smaller compared to ___ when it measured over 2.5 cm.\n\nLEFT BREAST:\nTargeted ultrasound of the retroareolar left breast in the area of clinical\nconcern demonstrates a heterogeneously hypoechoic fluid collection consistent\nwith an abscess measuring 6.3 x 3.8 x 5.4 cm. This is larger compared to the\nstudy of ___ when it measured approximately 3.1 cm in greatest\ndimension. This was subsequently drained under ultrasound guidance.", + "output": "1. Abscess in the retroareolar left breast measures up to 6.3 cm. This was\nsubsequently drained under ultrasound guidance.\n2. Improving abscess in the right breast measures up to 1.2 cm. Continued\nclinical management seems reasonable at this time.\n\nRECOMMENDATION(S): Ultrasound-guided drainage of left breast abscess.\n\nNOTIFICATION: Findings and recommendation for abscess drainage were reviewed\nwith the patient who agreed with the plan. The drainage was performed\nimmediately following this ultrasound.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Moderate left pleural effusion.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nposterior mid scapular line and 550 mL of clear serosanguineous fluid was\nremoved. Fluid samples were submitted to the laboratory for cell count,\ndifferential, culture, and cytology\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Ultrasound-guided paracentesis of the left pleural effusion with removal of\n550 mL of clear serosanguineous fluid. Samples were sent for analysis." + }, + { + "input": "LEFT BREAST ULTRASOUND: Targeted ultrasound of the left breast was performed.\nIn the left breast at ___ o'clock 4 cm from the nipple is a\nwell-circumscribed, oval, hypoechoic lesion measuring 0.4 x 0.3 x 0.3 cm it\nshows some posterior acoustic enhancement and no central peripheral\nvascularity and a stable since ___. Additionally in the left breast at\n___ o'clock 4 cm from the nipple is another oval well-circumscribed hypoechoic\nlesion measuring 0.5 x 0.2 x 0.5 cm. This is also stable ___.", + "output": "Probable benign lesions in the left breast. Given stability for over ___ year.\nFollowup ultrasound could be obtained in ___ year at the time of an mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM:\nTissue density: B - There are scattered areas of fibroglandular density.\nA BB marker is placed at the site of palpable abnormality indicated by the\npatient in the far posterior lower, outer right breast.\n No focal abnormality is seen at the site of the BB marker. There is no\ndominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast at ___\no'clock, 11 cm from the nipple was performed at the site of palpable\nabnormality indicated by the patient. There is no solid or cystic mass or\nfluid collection identified.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her annual\nscreening mammogram.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 53, 65, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 0.87.\nThe external carotid artery has peak systolic velocity of 229 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 85, 119, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 134 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Minimal, less than 40% stenosis of the right internal carotid artery. Mild,\n40- 59% stenosis of the left internal carotid artery. No evidence of\ndissection.\n\nNOTIFICATION: Findings discussed with Dr. ___ telephone at\napproximately 14:00 on ___." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous calcified\natherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 78, 60, and 67 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 226 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous calcified\natherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 88, 88, and 69 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 246 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate heterogeneous plaque involving the carotid bifurcations\nbilaterally.\n\n2. No hemodynamically significant stenosis involving either internal carotid\nartery (less than 40%).\n\n3. High velocities in both external carotid artery suggesting stenoses\ninvolving the ostia.\n\n4. Antegrade flow both vertebral arteries." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe questioned 0.9 cm asymmetry in the left slightly outer breast at posterior\ndepth on the CC view somewhat persists on the spot compression views though is\nless prominent. This localizes to the upper breast on the tomosynthesis views\nand there is a suggestion of an asymmetry in the upper breast at posterior\ndepth on spot compression views which may correlate. This was further\nevaluated by ultrasound. There is no architectural distortion or suspicious\ngrouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasounds performed of the left upper central\nand lower central breast from ___ o'clock 0-14 cm from the nipple and from\n___ o'clock 0-14 cm from the nipple. No suspicious solid or cystic mass was\nidentified.", + "output": "Probably benign left breast focal asymmetry without ultrasound correlate for\nwhich continued follow-up in 6 months with mammography is recommended.\n\nRECOMMENDATION(S): Left diagnostic mammogram in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no mammographic abnormality at the site of the patient's focal pain,\nas indicated by the triangular skin marker overlying the upper slightly outer\nleft breast at middle depth. There is no spiculated suspicious mass,\nsuspicious grouped microcalcifications, or unexplained architectural\ndistortion. A stable intramammary lymph node is present in the upper outer\nright breast, unchanged since ___.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast from ___ o'clock\nat 9 cm from the nipple, corresponding to the area of concern as indicated by\nthe patient, demonstrates no focal solid mass or cystic lesion.", + "output": "No focal mammographic or sonographic abnormality in the left breast at the\narea of clinical concern as indicated by the patient. Further management of\nthe patient's symptoms and any decision to biopsy should be based on the\nclinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is an right IJ line in place. Carotid artery not visualized.\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 95 cm/s / 27 cm/s\nCCA Distal: 100 cm/s / 28 cm/s\nICA ___: 70 cm/s / 26 cm/s\nICA Mid: 84 cm/s / 24 cm/s\nICA Distal: 66 cm/s / 24 cm/s\nECA: 65 cm/s\nVertebral: 59 cm/s\n\nICA/CCA Ratio: 0.8\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA could not be evaluated due to overlying dressing and presence of a\ncentral line.\nLeft ICA without evidence of stenosis." + }, + { + "input": "Targeted images of the liver demonstrate a rounded hypoechoic lesion within\nthe posterior right hepatic lobe measuring 6.1 x 5.1 x 5.7 cm, without\ninternal vascularity. No additional lesions are demonstrated.", + "output": "6.1 cm avascular right hepatic hypoechoic lesion compatible with a hepatic\nabscess." + }, + { + "input": "Targeted ultrasound of both axillary regions was performed. No suspicious\nsolid or cystic masses are seen. Normal appearing axillary lymph nodes are\nnoted. No abnormal appearing lymph nodes are seen in either axilla.\nPalpable lump identified by the patient at 2:00 position 7 cm from the nipple\ncorresponds to a round 5 mm nearly anechoic mass with increased through\ntransmission and no internal vascularity, which appears to originate in the\nskin. No definite tract was seen towards the skin surface, however there is\nan overlying skin punctum on physical exam.", + "output": "There is a probably benign palpable 5 mm mass at 2:00 position 7 cm from the\nnipple in the right breast, most likely representing a sebaceous cyst. The\npatient is going to be seen in the breast Care ___ this lump and\nexpressed an interest in having this area surgically excised. If not excised,\nthen six-month follow-up is recommended to document expected stability and\nbenign appearance of this mass.\n\nNo suspicious sonographic abnormalities seen in both axillary regions in the\narea of fullness on recent physical exam.\n\nRECOMMENDATION(S): Ultrasound follow-up in 6 months of a probably benign\nright breast mass at 2:00 position 7 cm from the nipple. Clinical follow-up\nfor the areas of fullness in both axillae.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the right breast was performed. At the 3 o'clock\nposition approximately 7 cm from the nipple, there is a heterogeneous\ncollection with scattered internal echoes measuring 2.2 x 0.7 x 1.1 cm, 2 mm\nbelow the skin surface. This finding appears to superimposed over the\npreviously seen probable benign mass measuring 6 mm, previously characterized\nas likely sebaceous cyst.", + "output": "1. Heterogeneous collection with scattered internal echoes measuring 2.2 x 0.7\nx 1.1 cm at the 3 o'clock position of the right breast, 2 mm below the skin\nsurface.\n2. This finding appears to be superimposed over the previously seen probable\nbenign mass measuring 6 mm, previously characterized as likely sebaceous cyst\non prior ultrasound from ___.\n\nRECOMMENDATION(S): Recommend further evaluation with dedicated assessment in\nthe Breast Care ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\n1. Heterogeneous collection with scattered internal echoes measuring 2.2 x 0.7\nx 1.1 cm at the 3 o'clock position of the right breast, likely consistent with\nan abscess.\n2. This finding appears to be superimposed over the previously seen probable\nbenign mass measuring 6 mm, previously characterized as likely sebaceous cyst\non prior ultrasound from ___." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 70, 42, and 57 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 103 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 54, 74, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 70 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the internal carotid arteries." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.1 L of yellow fluid were removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis.\n2. 2.1 L of fluid were removed." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no suspicious mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy. No sonographic abnormality\nin the left breast areas of clinical concern. In the absence of imaging\nfindings, any decision for further intervention should be guided by the\nclinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up, annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 59, 59, and 83 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.09.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 58, 86, and 43 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 46 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis bilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate to severe atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 90, 77, and 106 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 142 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 80, 74, and 108 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 171 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate bilateral extracranial internal carotid atherosclerotic plaque\nwithout significant stenosis (less than 40%). . Normal antegrade flow both\nvertebral arteries." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nDensity is noted in the central upper right breast measuring 2.8 x 3.4 x 3.5\ncm. This presumably corresponds to the known abscess. Nodularity in the\ninner left breast corresponds to vessels on subsequent imaging. No additional\nabnormalities are identified in either breast.\n\nRIGHT BREAST ULTRASOUND: At 12 o'clock 2-3 cm from the nipple in the area of\nconcern there is a 2.6 x 1.3 x 2.6 cm heterogeneous area corresponding to the\nknown abscess. It appears less drainable on the current examination but\noverall is little changed from examination on ___.", + "output": "Persistent collection in the right breast in the area of clinical concern.\n\nRECOMMENDATION(S): Continued clinical follow-up. Follow-up imaging in 5 days\nis recommended to evaluate for interval change.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "There is a complex, heterogeneous collection measuring 2.5 x 2.3 x 1.4 cm,\nlocated at approximately 1 o'clock near the nipple, and which demonstrates\nsome peripheral vascularity. The collection contains avascular echogenic\nmaterial, which is nonspecific, but could represent internal debris. The\ncollection is approximately 9 mm deep to the skin.", + "output": "2.5 x 2.3 x 1.4 cm right breast complex collection concerning for abscess, as\nabove." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nDensity is noted in the central upper right breast measuring 2.8 x 3.4 x 3.5\ncm. This presumably corresponds to the known abscess. Nodularity in the\ninner left breast corresponds to vessels on subsequent imaging. No additional\nabnormalities are identified in either breast.\n\nRIGHT BREAST ULTRASOUND: At 12 o'clock 2-3 cm from the nipple in the area of\nconcern there is a 2.6 x 1.3 x 2.6 cm heterogeneous area corresponding to the\nknown abscess. It appears less drainable on the current examination but\noverall is little changed from examination on ___.", + "output": "Persistent collection in the right breast in the area of clinical concern.\n\nRECOMMENDATION(S): Continued clinical follow-up. Follow-up imaging in 5 days\nis recommended to evaluate for interval change.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound in the right breast at 12 o'clock 2-3 cm from the nipple\nin the area of concern as indicated by the patient demonstrates a\nheterogeneously hypoechoic fluid collection with an echogenic and vascular\nperiphery consistent with abscess. This measures 2.4 x 2 x 1.2 cm and\npreviously measured 2.6 x 2.6 x 1.3 cm. Any decision to intervene at this\ntime should be based on the clinical assessment.", + "output": "Improving known right breast abscess at 12 o'clock measuring 2.4 cm, for which\nclinical management is recommended at this time. Any decision to intervene at\nthis time should be based on the clinical assessment.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient\nthrough an interpreter who agrees with the plan.\n\n The findings were discussed with ___, N.P. by ___, M.D. on\nthe telephone on ___ at 08:55.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 3 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(hematology and microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 2.75 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.75 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 1.6 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 1.6 L of fluid were removed and sent for requested analysis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 91 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 78, 89, and 86 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 94 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 99 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 81, 90, and 92 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 37 cm/sec.\nThe ICA/CCA ratio is 0.91.\nThe external carotid artery has peak systolic velocity of 111 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of significant stenosis in the internal carotid arteries\nbilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 80, 88, and 88 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 14 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 92 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 79 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 96, 80, and 58 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 13 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 89 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No plaque or stenosis right. Mild left ICA ___ stenosis" + }, + { + "input": "Normal vascular structures are seen in the right groin. Doppler assessment of\nthe femoral artery and vein is normal. No evidence for hematoma. No evidence\nfor pseudoaneurysm.", + "output": "No ultrasound or Doppler abnormality seen in the right groin. No hematoma. No\npseudoaneurysm." + }, + { + "input": "RIGHT:\nRight common iliac artery is patent without evidence of plaque. Diameter is 9\nmm.\nRight external iliac artery is patent without evidence of plaque. Diameter is\n8 mm.\nRight common femoral artery is patent without evidence of plaque. Diameter is\n10 mm.\nRight superficial femoral artery is patent without evidence of plaque. \nDiameter is 8 mm.\nRight deep femoral artery is patent without evidence of plaque. Diameter 7\nmm.\n\nLEFT:\nLeft common iliac artery is patent without evidence of plaque. Diameter is 8\nmm.\nLeft external iliac artery is patent without evidence of plaque. Diameter is\n10 mm.\nLeft common femoral artery is patent without evidence of plaque. Diameter is\n8 mm.\nLeft superficial femoral artery is patent without evidence of plaque. \nDiameter matter is 6 mm.\nLeft deep femoral artery is patent without evidence of plaque. Diameter is 6\nmm.", + "output": "Patent bilateral iliac and femoral vasculature without significant plaque and\ndiameters as above." + }, + { + "input": "Only trace fluid within the joint space could be aspirated.", + "output": "A trace amount of synovial fluid was sent for microbiology analysis." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nAdditional views confirm a 1.1 x 0.6 cm focal asymmetry within the upper and\nslightly inner left breast mid to posterior depth (ML tomosynthesis image 37\nand CC tomosynthesis image 28) which may have some associated architectural\ndistortion and was further evaluated with ultrasound. There is no additional\ndominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound ___ o'clock left breast 1-9 cm from\nthe nipple performed to cover area of concern as seen on the mammogram. There\nis a mixed echogenic region at 11 o'clock left breast 7 cm from the nipple\nmeasuring 0.9 x 0.6 x 0.8 cm which may correspond to the mammographic\nfindings. No associated internal vascularity.", + "output": "Indeterminate 1.1 cm focal asymmetry within the upper and slightly inner left\nbreast mid to posterior depth with possible associated architectural\ndistortion with questionable sonographic correlate 11 o'clock left breast 7 cm\nfrom the nipple. As the finding is best identified on tomosynthesis,\ntomosynthesis guided biopsy on upright unit is recommended.\n\nRECOMMENDATION(S): Tomosynthesis guided biopsy of left breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n63/19 cm/sec in its proximal portion, 79/24 cm/sec in its mid portion, and\n102/34 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n71/18 cm/sec.\nThe external carotid artery has peak systolic velocity of 63 cm/sec.\nThe vertebral artery has peak systolic velocity of 69 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.4.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n89/24 cm/sec in its proximal portion, 83/27 cm/sec in its mid portion, and\n107/36 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 69/18\ncm/sec.\nThe external carotid artery has peak systolic velocity of 106 cm/sec.\nThe vertebral artery has peak systolic velocity of 32 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.5.", + "output": "Mild heterogeneous plaque in the bilateral internal carotid, external carotid\nand common carotid arteries without evidence of significant carotid artery\nstenosis bilaterally, unchanged compared to the prior study from ___." + }, + { + "input": "Limited ultrasound evaluation of the left lower quadrant transplant pancreas\ndemonstrates normal echotexture of the pancreatic parenchyma without edema or\nperipancreatic fluid. No abscess is identified. The pancreatic duct is not\ndilated. Spectral Doppler waveform analysis demonstrates normal arterial and\nvenous waveforms in the proximal, mid and distal transplant pancreas.", + "output": "Normal ultrasound evaluation of the left lower quadrant transplant pancreas." + }, + { + "input": "At least 2 mildly hyperechoic lesions were identified within the lateral\nsegment of the left hepatic lobe, corresponding to the lesions on prior\nultrasound and MRI, 1 of which was targeted for biopsy. Targeted lesion\nmeasured 1.5 cm, previously 1.6 cm.", + "output": "Technically successful ultrasound guided biopsy of left-sided liver lesion. 3\nsamples (18 gauge cores) were submitted for pathology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 52, 40, and 47 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.81.\nThe external carotid artery has peak systolic velocity of 67 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 44, 55, and 44 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.96.\nThe external carotid artery has peak systolic velocity of 61 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Normal bilateral extracranial internal carotid arteries without significant\natherosclerotic plaque or stenosis." + }, + { + "input": "At ___ o'clock 4-5 cm from the nipple in the area of concern on mammography is\nidentified a 0.6 x 0.3 x 0.7 cm solid mass with a coarse echogenic focus\nlikely correspondingto a coarse calcification on mammography. The imaging\nappearance is suggestive of an involuted fibroadenoma. Incidental note was\nalso made of a solid circumscribed mass at 2 o'clock 2-3 cm from the nipple\nmeasuring 0.9 x 0.4 x 1.0 cm. Given the multiplicity of findings, this does\nfavor a benign process such as multiple fibroadenoma and six-month followup\nultrasound to document stability seems a reasonable approach at this time. If\nthere is a need for more immediate diagnostic certainty, ultrasound-guided\ncore biopsy could be undertaken.", + "output": "Two probable benign solid masses in the left breast favoring fibroadenomas. \nSix-month follow-up ultrasound represent a reasonable approach at this time.\n\nRECOMMENDATION: Left breast ultrasound in 6 months\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the left breast at ___ o'clock 4-5 cm from the nipple there is a 0.6 x 0.3\nx 0.6 cm hypoechoic mass with a central calcification unchanged since ___ when it measured 0.7 x 0.6 x 0.3 cm, which likely represents an\ninvoluting fibroadenoma. At ___ o'clock 2 cm from the nipple a circumscribed\noval hypoechoic mass measuring 0.9 x 0.7 x 0.4 cm is not significantly changed\nfrom prior study allowing for differences in measuring technique when it\nmeasured 1.0 x 0.7 x 0.4 cm.", + "output": "Six month stability of probably benign masses in the left breast. Continued\nfollow-up in six months is recommended, at the time the patient will be due\nfor her annual mammogram.\n\nRECOMMENDATION(S): Six-month follow-up left breast ultrasound, at the time\nthe patient will be due for her annual mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nAgain seen oval mass in the lower slightly outer left breast at mid depth with\nassociated coarse calcification, unchanged since the prior mammogram from ___. There are no grouped suspicious microcalcifications or unexpected\narchitectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast at ___ o'clock 4-5\ncm from the nipple demonstrates an oval circumscribed mass containing a coarse\ncalcification measuring 0.6 x 0.3 x 0.6 cm (previously 0.6 x 0.3 x 0.7 cm).\n\nTargeted ultrasound of the left breast at 2 o'clock 2-3 cm from the nipple\ndemonstrates an oval, circumscribed hypoechoic mass measuring 0.8 x 0.4 x 0.8\ncm (previously 0.9 x 0.4 x 1 cm). Incidental note is made of a 2 mm simple\ncyst at ___ o'clock in the left breast at 2 cm from the nipple.", + "output": "Left breast masses demonstrate ___ year stability. A follow-up is recommended\nin ___ year.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and left breast ultrasound\nin ___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has small degree of heterogeneous\natherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 72 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 45, 72, and 79 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 18\ncm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 124 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has small degree of heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 65, 59, and 67 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 21\ncm/sec.\nThe ICA/CCA ratio is 0.70.\nThe external carotid artery has peak systolic velocity of 96 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant plaque or stenosis in the internal carotid\narteries" + }, + { + "input": "Within the anterior abdominal wall subcutaneous fat adjacent to the existing\ndrainage catheter tract there is a thin fluid collection measuring maximally\n2.3 cm in diameter. This is too small for a drain to be placed, however the\ncollection was aspirated until the cavity collapsed.", + "output": "Successful US-guided aspiration of a thin anterior abdominal wall fluid\ncollection which was too small for a drain to be placed. Samples was sent for\nmicrobiology evaluation." + }, + { + "input": "Postprocedure image demonstrates adequate placement of a pigtail catheter in\nwithin the anterior abdominal wall collection.", + "output": "Successful US-guided placement of ___ pigtail catheter into an anterior\nabdominal wall collection. Samples was sent for microbiology evaluation." + }, + { + "input": "The aorta measures 2.5 cm in the proximal portion, 1.9 cm in mid portion and\n1.8 cm in the distal abdominal aorta. There is mild calcified and\nnoncalcified atherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.2 cm and the left common iliac\nartery measures 1.4 cm.\n\nThe right kidney measures 12 cm and the left kidney measures 10.3 cm. Mild\ncaliectasis is seen on the right, as on prior likely secondary to a capacious\nright extrarenal pelvis.", + "output": "No abdominal aortic aneurysm." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque predominately within the internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 92 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 121, 104, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 118 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous atherosclerotic plaque\nwithin the internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 85 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 145, 90, and 59 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 47 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 83 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate bilateral heterogeneous atherosclerotic plaque within the internal\ncarotid arteries resulting in 40-59% stenosis." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nBilateral postsurgical changes are again seen consistent with known reduction\nmammoplasty. In addition, there are stable postsurgical changes in the left\ncentral inner breast. The focally dilated ductal system in the slightly outer\ncentral to upper right breast appears stable continuing to favor a benign\nprocess. Other scattered benign appearing nodular areas within both breasts\nare also unchanged consistent with benign findings. There is no suspicion\nmass or suspicious grouped microcalcifications in either breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast from the 9 to 10\no'clock 0-8 cm from the nipple in the area of concern on prior imaging\ndemonstrated a mildly dilated branching duct with no intraductal mass or solid\nsuspicious lesion.", + "output": "Stable probable benign right duct ectasia for which continued followup imaging\nin ___ year seems the most reasonable approach at this time. Bilateral\npostsurgical changes.\n\nRECOMMENDATION(S): Bilateral diagnostic mammography and right breast\nultrasound in one year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "A mildly hyperechoic lobulated and ill-defined mass is seen primarily in\nsegments 2 and 4A with caudal extension down to the portal bifurcation with no\nevidence of direct invasion of the portal veins. The mass appears to be\nentirely to the left of the middle hepatic vein. A hypoechoic somewhat\ncurvilinear structure is seen just lateral to the middle hepatic vein which\nappears to correspond to the intrahepatic portion of the hematoma which has\nbeen slowly resolving since the liver biopsy in ___.", + "output": "Ill-defined mildly hyperechoic mass primarily sided in segments 2 and 4A and\nsituated to the left of the middle hepatic vein." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin the common carotid artery.\nThe peak systolic velocity in the right common carotid artery is 139 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 64, 68, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 0.48.\nThe external carotid artery has peak systolic velocity of 96 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque\nwithin the common carotid and external carotid arteries.\nThe peak systolic velocity in the left common carotid artery is 113 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 86, 78, and 88 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 0.78.\nThe external carotid artery has peak systolic velocity of 183 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. No significant atherosclerotic plaque or hemodynamically significant\nstenosis within the internal carotid arteries, bilaterally." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance at bedside, an entrance site was selected and the\nskin was prepped and draped in the usual sterile fashion. 1% lidocaine was\ninstilled for local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.5 L of clear yellow fluid was removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, culture, and\ncytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Ultrasound guided paracentesis with removal of 6.5 L clear yellow fluid." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and demonstrated perihepatic ascites. Therefore,\nascitic fluid drainage was performed through the existing PleurX catheter. \n1.7 L clear yellow fluid was removed. After that, a suitable approach for non\ntargeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n0.5 mg Versed and 25 mcg fentanyl throughout the total intra-service time of\n12 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy.\n\nRemoval of 1.7 L clear yellow ascites through the existing PleurX catheter." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 162, 79, and 70 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 2.5.\nThe external carotid artery has peak systolic velocity of 94 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 97 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 79, 63, and 86 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 0.88.\nThe external carotid artery has peak systolic velocity of 58 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate heterogeneous plaque within the right internal carotid artery with\n60-69% stenosis.\n2. Mild heterogeneous plaque within the left internal carotid artery with less\nthan 40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque. \nThere is wall thickening of the right common carotid artery\nThe peak systolic velocity in the right common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 65, 108, and 89 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 40 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 154 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque. \nThere is wall thickening of the left common carotid artery.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 41, 53, and 49 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.72.\nThe external carotid artery has peak systolic velocity of 40 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the bilateral internal carotid arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogenous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 32 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 47, 47, and 40 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 62 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogenous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 46 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 86, 139, and 85 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 38 cm/sec.\nThe ICA/CCA ratio is 3.0.\nThe external carotid artery has peak systolic velocity of 74 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "___ <40%; LICA 40-59% stenosis.\nAntegrade vertebral flow." + }, + { + "input": "LIVER: The liver is diffusely echogenic. There are areas The contour of the\nliver is smooth. There is no focal liver mass. The main portal vein is patent\nwith hepatopetal flow. There is no ascites.\n\nBILE DUCTS: There is no intrahepatic biliary dilation. The CBD measures 4 mm.\n\nGALLBLADDER: There is no evidence of stones or gallbladder wall thickening.\n\nKIDNEYS: The right kidney measures 11.1 cm and appears normal, without masses,\nstones, or hydronephrosis.\n\nRETROPERITONEUM: Visualized portions of aorta and IVC are within normal\nlimits.", + "output": "1. Echogenic liver consistent with steatosis. Other forms of liver disease\nincluding hepatic fibrosis or cirrhosis or steatohepatitis cannot be excluded\non the basis of this examination.\n2. No concerning hepatic lesions or focal fluid collections. No intra or\nextrahepatic bile duct dilation.\n3. Normal gallbladder." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nRight Breast:\nThere is no other dominant mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. There is no significant change.\nLeft Breast:\nA BB was placed over the palpable area in the left axilla. There is no\ndiscrete mass underlying the BB. There is no other dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications. There is\nno significant change.\n\nBREAST ULTRASOUND : Targeted ultrasound of the left axilla was performed. \nThere is no discrete solid or cystic mass underlying the palpable area\nindicated by the patient.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening. Final disposition of\npalpable area should be based on clinical evaluation.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 1 Negative." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nRight Breast:\nThere is no other dominant mass, unexplained architectural distortion or\nsuspicious grouped microcalcifications. There is no significant change.\nLeft Breast:\nA BB was placed over the palpable area in the left axilla. There is no\ndiscrete mass underlying the BB. There is no other dominant mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications. There is\nno significant change.\n\nBREAST ULTRASOUND : Targeted ultrasound of the left axilla was performed. \nThere is no discrete solid or cystic mass underlying the palpable area\nindicated by the patient.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening. Final disposition of\npalpable area should be based on clinical evaluation.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\n\n\n BI-RADS: 1 Negative." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nA 2-3 mm group of indeterminate microcalcifications are noted in the\nupper-outer right breast with an associated 5 mm focal asymmetry, which is\nbetter seen on the CC view, further evaluated with ultrasound. Posttreatment\nchanges in the right breast are stable with surgical clips, architectural\ndistortion and dystrophic calcifications in the posterior depth upper central\nright breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast from 9\no'clock to 12 o'clock, 5-15 cm from the nipple at the site of mammographic\nabnormality was performed. No suspicious solid or cystic mass is identified. \nThere is no sonographic correlate for the right breast focal asymmetry with\ncalcifications.\n\nUltrasound of the right axilla demonstrates morphologically normal appearing\nright axillary lymph nodes with normal cortical thicknesses.", + "output": "1. 2-3 mm group of indeterminate microcalcifications in the upper-outer right\nbreast and associated 5 mm focal asymmetry without a sonographic correlate.\n2. Normal appearing right axillary lymph nodes.\n\nRECOMMENDATION(S): Stereotactic core biopsy of indeterminate right breast\ncalcifications and associated focal asymmetry.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy, currently scheduled for ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nAgain seen are posttreatment changes in the central upper right breast. A\npercutaneous biopsy clip is seen in the outer slightly upper right breast.\n\nThere is a 1.1 cm irregular, spiculated mass in the upper, slightly inner\nright breast at posterior depth.\n\nThere is a 0.7 cm irregular, indistinct mass in the upper, outer right breast\nat medium depth.\n\nThere is a 2.4 x 2.2 x 3.0 cm (transverse by AP by SI) area of\nmicrocalcifications in the slightly medial retroareolar right breast. The\ncalcifications are punctate and have a linear distribution in the medial-most\naspect.\n\nBREAST ULTRASOUND:\nAt ___ o'clock 11 cm from the nipple, there is a 1.0 x 0.9 x 0.8 cm irregular\nhypoechoic mass with angular margins and internal vascularity, corresponding\nto the new spiculated mass in the upper inner right breast at posterior depth.\n\nAt 10 o'clock 7 cm from the nipple, there is a 0.8 x 0.5 x 1.0 cm irregular\nhypoechoic mass, correlating to the mass in the outer right breast.\nUltrasound of the right axilla was performed revealing normal-appearing lymph\nnodes.", + "output": "1. Suspicious 1.0 cm right breast mass at ___ o'clock 11 cm from the nipple\nfor which ultrasound-guided core biopsy will be performed on the same day.\n2. Suspicious 0.8 cm right breast mass at 10 o'clock 7 cm from the nipple.\n3. Suspicious 3.0 cm area of microcalcifications in the slightly medial\nretroareolar right breast. The decision to proceed with stereotactic core\nbiopsy will depend on the results of today's same-day ultrasound-guided core\nbiopsy and surgical planning.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the posterior right\nbreast mass.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. The patient will have the biopsy later on the same\ndate. The impression and recommendation above was entered by Dr. ___\n___ on ___ at 12:02 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nAgain seen are posttreatment changes in the central upper right breast. A\npercutaneous biopsy clip is seen in the outer slightly upper right breast.\n\nThere is a 1.1 cm irregular, spiculated mass in the upper, slightly inner\nright breast at posterior depth.\n\nThere is a 0.7 cm irregular, indistinct mass in the upper, outer right breast\nat medium depth.\n\nThere is a 2.4 x 2.2 x 3.0 cm (transverse by AP by SI) area of\nmicrocalcifications in the slightly medial retroareolar right breast. The\ncalcifications are punctate and have a linear distribution in the medial-most\naspect.\n\nBREAST ULTRASOUND:\nAt ___ o'clock 11 cm from the nipple, there is a 1.0 x 0.9 x 0.8 cm irregular\nhypoechoic mass with angular margins and internal vascularity, corresponding\nto the new spiculated mass in the upper inner right breast at posterior depth.\n\nAt 10 o'clock 7 cm from the nipple, there is a 0.8 x 0.5 x 1.0 cm irregular\nhypoechoic mass, correlating to the mass in the outer right breast.\nUltrasound of the right axilla was performed revealing normal-appearing lymph\nnodes.", + "output": "1. Suspicious 1.0 cm right breast mass at ___ o'clock 11 cm from the nipple\nfor which ultrasound-guided core biopsy will be performed on the same day.\n2. Suspicious 0.8 cm right breast mass at 10 o'clock 7 cm from the nipple.\n3. Suspicious 3.0 cm area of microcalcifications in the slightly medial\nretroareolar right breast. The decision to proceed with stereotactic core\nbiopsy will depend on the results of today's same-day ultrasound-guided core\nbiopsy and surgical planning.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the posterior right\nbreast mass.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. The patient will have the biopsy later on the same\ndate. The impression and recommendation above was entered by Dr. ___\n___ on ___ at 12:02 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "In the right breast at ___ o'clock, 11 cm from the nipple there is a 1 x 0.9\nx 0.9 cm hypoechoic mass with echogenic halo. This lesion was targeted for\nbiopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised\nby ___. ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Sertera spring-loaded biopsy device. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. No significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast mass at ___\no'clock. Pathology is pending.\n\nThe patient expects to hear the pathology results from ___. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "In the right breast at ___ o'clock, 11 cm from the nipple there is a 1 x 0.9\nx 0.9 cm hypoechoic mass with echogenic halo. This lesion was targeted for\nbiopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___, M.D.. The procedure was supervised\nby ___. ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Sertera spring-loaded biopsy device. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance. \nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement. No significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast mass at ___\no'clock. Pathology is pending.\n\nThe patient expects to hear the pathology results from ___. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "TiBREAST ULTRASOUND: I palpated the upper outer quadrant of the left breast\nand was able to appreciate a superficial pea size lump at approximately 1\no'clock. Scans directly over this area demonstrated a slightly irregular\nsuperficial mass with a single feeding vessel measuring approximately 0.7 x\n0.9 x 0.6 cm. Subsequently a mammogram of this finding was performed.\n\n\nTissue density: B- There are scattered areas of fibroglandular density.\n\nSpot compression views of the palpable lump in tangent demonstrates a slightly\nirregular superficial dlow-density mass without calcification measuring\napproximately 8.5 mm.", + "output": "Left breast: Palpable left breast mass at 1 o'clock is suspicious. Although\nfat necrosis is in the differential malignancy should be excluded.\n\nRECOMMENDATION(S): Left breast ultrasound-guided biopsy.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n The impression and recommendation above was entered by Dr. ___ on\n___ at 15:25 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Again seen is a hyperechoic mass in the left breast at 01:00 o'clock as seen\non prior ultrasound from ___.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___. ___, N.P. The procedure was\nsupervised by ___, M.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Sertera spring-loaded biopsy device. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Again seen is a hyperechoic mass in the left breast at 01:00 o'clock as seen\non prior ultrasound from ___.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D., ___. ___, N.P. The procedure was\nsupervised by ___, M.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Sertera spring-loaded biopsy device. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Multinodular goiter. 25 gauge FNA x 3 of left thyroid nodule at junction of\nupper pole and interpolar region demonstrating a coarse calcification was\nperformed.", + "output": "Successful FNA of left thyroid nodule." + }, + { + "input": "In the right breast, at 4'o clock and superficial to the breast implant, there\nis an avascular collection of fluid measuring up to 2.4 cm TV x 0.6 cm AP x\n3.8 cm CC, which could reflect a seroma however superimposing infection cannot\nbe excluded. Fluid collection appears separate from the implant.", + "output": "4 cm fluid collection superficial to the breast implant, superimposed\ninfection cannot be excluded.\n\nSubsequent chest CTA performed same day better demonstrated large fluid\ncollection surrounding the right breast implant and which contains VP shunt\ncatheter. See that report for further details.\n\n4 cm fluid collection superficial to the breast implant, \npossibly seroma however superimposed infection cannot be excluded.\nSubsequent CT better demonstrated large fluid collection surrounding the right\nbreast implant." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated traceascites.\nA suitable target in the deepest pocket in the subhepatic space was selected\nfor paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nPreprocedure ultrasound demonstrated trace ascites, mostly in the subhepatic\nrecess so decision was made to proceed with diagnostic paracentesis only. An\nentrance site was selected and the skin was prepped and draped in the usual\nsterile fashion. 1% lidocaine was instilled for local anesthesia. Under\nrealtime ultrasound guidance, a 20G spinal needle was advanced into the\nsubhepatic recess and 20 cc clear, yellow ascites was aspirated.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the entirety of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated realtime ultrasound-guided diagnostic paracentesis with\naspiration of 20cc clear, yellow ascites. Only diagnostic paracentesis was\nperformed due to trace ascites volume. Samples were sent to the laboratory\nper primary team orders." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 8.75 L of serosanguinous fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 8.75 L of fluid were removed." + }, + { + "input": "Limited ultrasonographic evaluation of the right upper quadrant demonstrates\ndistended gallbladder which shows wall thickening with sludge within it. \nLimited postprocedure images demonstrates successful placement of ___\npigtail catheter into the gallbladder", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are stable bilateral postsurgical changes. There is no suspicious mass,\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications. Asymmetries in the upper outer right breast and the\ncentral left breast disperse with additional views consistent with\nsuperimposition of benign parenchyma and postsurgical changes.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy. Bilateral postsurgical\nchanges.\n\nRECOMMENDATION(S): Clinical follow-up, age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the subareolar left breast was\nperformed which was without any discrete suspicious solid or cystic masses.", + "output": "There are no suspicious mammographic or sonographic findings to explain left\nnipple discharge. No specific mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 70 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 54, 73, and 70 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 33\ncm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 88 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has severe heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 93, 98, and 99 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 30\ncm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 89 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.5 L of blood-tinged, slightly cloudy fluid were removed.\nFluid samples were submitted to the laboratory for cell count, differential,\nculture, and cytology. Please note that according to patient, the previously\ndrained fluid looked very 'milky or milk-shake like' and different in\nappearance compared to fluid retrieved on this paracentesis.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3.5 L of thin milky pink fluid were removed. Fluid samples were submitted\nto the laboratory for cell count, differential, culture, and cytology." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 15 mL 1% lidocaine. Under real-time ultrasound\nguidance, a 16 gauge core biopsy needle was then advanced into the liver and a\nsingle core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 10\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "This examination was initially scheduled to be a diagnostic and therapeutic\nparacentesis. There was very little ascites seen. This was mainly seen as a\nsliver of free fluid around the hepatic contour, and again as very minimal\nfree fluid in the deep pelvis. The procedure was deemed not technically\nfeasible.", + "output": "Trace amount of ascites, not sufficient for diagnostic aspiration." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the suprapubic region was\nselected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the\nsuprapubic region and 20 cc of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated diagnostic paracentesis yielding 20 cc of clear, straw-colored\nascites as detailed above. Samples were sent for cell count and culture. ." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 point L of clear, straw-colored fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated diagnostic and therapeutic paracentesis yielding 2.6 L of\nstraw-colored ascites as detailed above." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 20 cc of yellow fluid was removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic paracentesis with removal\nof 20 cc of yellow ascites." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.5 L of turbid yellow fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Ultrasound-guided paracentesis from the right lower quadrant with removal of\n5.5 L turbid yellow fluid." + }, + { + "input": "There is moderate right superficial femoral artery plaque.\n\nPeak systolic velocities are as follows:\n\nCommon femoral artery waveform is triphasic. Peak systolic velocity is 89\ncm/sec.\nProximal superficial femoral artery waveform is triphasic. Peak systolic\nvelocity is 91 cm/sec\nMid superficial femoral artery waveform is triphasic. Peak systolic velocity\nis 127 cm/sec\nDistal superficial femoral artery waveform is triphasic. Peak systolic\nvelocity is 112 cm/sec\nPopliteal artery waveform is biphasic. Peak systolic velocity is 101 cm/sec\nproximally and 148 cm/sec distally\nPosterior tibial artery waveform is biphasic. Peak systolic velocity is 52\ncm/sec\nPeroneal artery waveform is biphasic. Peak systolic velocity is 44 cm/sec", + "output": "Patent left lower extremity arterial system with triphasic flow above the\npopliteal artery and biphasic flow below the popliteal artery. For detailed\ndescription of velocities please refer to the body of the report." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a palpable marker the areola in the upper slightly outer left breast\nwith mild skin thickening. There is no suspicious mass, unexplained\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which demonstrated mild\nskin thickening. There is no discrete suspicious solid or cystic masses.", + "output": "1. There is mild skin thickening in the area of clinical concern at the\nareola of the left breast without suspicious features.\n2. There is no evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Annual mammography. Recommend clinical follow-up and\nfinal disposition of any clinical findings based on clinical grounds. No\nfurther imaging follow-up is felt to be necessary of this finding at this\ntime.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a mass with obscured borders seen in the upper central breast, mid\ndepth. This is better visualized on the CC than on the MLO spot view. It\nmeasures approximately 1.3 cm\nBREAST ULTRASOUND: Targeted examination to the upper central portion of the\nbreast demonstrates the presence of a cyst measuring 1.3 x 1.4 cm with a\nsecond small cyst adjacent to the medial border. A few additional very small\ncysts were seen in the region. No solid masses or shadowing abnormalities\nwere noted.", + "output": "Recall of the left breast for a mass on screening mammography confirms the\npresence of such at the 12 o'clock position and a corresponding cyst seen on\nsame-day ultrasound.\n\nRECOMMENDATION: Routine screening\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 59 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 63, 70, and 104 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 69 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 64, 64, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.81.\nThe external carotid artery has peak systolic velocity of 55 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has echogenic heterogeneous atherosclerotic\nplaque in the bulb and proximal ICA.\nThe peak systolic velocity in the right common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 73, 83, and 90 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has heterogeneous atherosclerotic plaque at the\ncarotid bulb and proximal ICA.\nThe peak systolic velocity in the left common carotid artery is 96 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 61, 91, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 77 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Heterogeneous plaque in the carotid bulbs and proximal ICAs bilaterally with\nless than 40% stenosis of the ICAs. This is not significantly changed from\nthe prior examination" + }, + { + "input": "Targeted ultrasound of the left breast at 1 o'clock 0-12 cm from the nipple\ndemonstrates no suspicious mass or suspicious sonographic finding.", + "output": "No sonographic correlate to the area palpable concern. Clinical follow-up is\nsuggested.\n\nRECOMMENDATION(S): Clinical follow-up for the area palpable concern as\nindicated by the patient.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nThere is an approximately 13 mm circumscribed oval equal density mass seen in\nthe right central lower breast, at the location of the palpable abnormality. \nThere is no suspicious microcalcification or unexplained architectural\ndistortion in either breast.\n\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at the site of palpable\nlump which demonstrated an oval parallel circumscribed hypoechoic mass without\ndominant vascularity at the ___ position, 3 cm from the nipple, measuring\n1.3 x 1.1 x 0.4 cm, corresponding to the mammographic finding.", + "output": "Palpable right breast lump felt by the patient corresponds to a 13 mm\nbenign-appearing mass at the ___ position, likely a fibroadenoma.\n\nRECOMMENDATION(S): Continued follow-up with right breast ultrasound is\nrecommended in 6 months to document stability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Again seen in the right breast at ___ o'clock 3 cm from the nipple is a 0.9 x\n0.4 x 1.2 cm oval, circumscribed, parallel hypoechoic mass with minimal\ninternal vascularity which is unchanged in size and appearance since ___ and is probably benign.", + "output": "Six-month stability probably benign mass in the right breast for which\ncontinued follow-up in 6 months with ultrasound is recommended.\n\nRECOMMENDATION(S): Right breast ultrasound in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At 7 8 o'clock 3 cm from the nipple is identified a 1.0 x 0.3 x 0.9 cm solid\nslightly hypoechoic mass which is stable, if not slightly smaller, when\ncompared to prior imaging. This continues to favor a benign process and\ncontinued followup imaging in one year seems reasonable at this time.", + "output": "Stable, if not slightly smaller, probable benign mass in the right breast is\n___ o'clock for which continued followup imaging in one year seems reasonable\nat this time.\n\nRECOMMENDATION: Bilateral diagnostic mammography and right breast ultrasound\nin one year.\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n97/18 cm/sec in its proximal portion, 67/14 cm/sec in its mid portion, and\n54/9 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of 58/7\ncm/sec.\nThe external carotid artery has peak systolic velocity of 55 cm/sec.\nThe vertebral artery has peak systolic velocity of 39 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.7.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n61/9 cm/sec in its proximal portion, 83/14 cm/sec in its mid portion, and 62/2\ncm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 53/6\ncm/sec.\nThe external carotid artery has peak systolic velocity of 65 cm/sec.\nThe vertebral artery has peak systolic velocity of 52 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.6.", + "output": "1. Mild heterogeneous plaque in the bilateral internal carotid arteries. Less\nthan 40% stenosis bilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 79 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 55, 74, and 75 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 0.95.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 84 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 59, 69, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.94.\nThe external carotid artery has peak systolic velocity of 47 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral carotid plaques without hemodynamically significant stenosis." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. Again noted is diffuse echogenicity of the hepatic\nparenchyma.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n10 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Technically successful non-targeted liver biopsy." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nFINDING: On the right, there is a circumscribed lobulated mass/asymmetry in\nthe upper-outer quadrant which is of mixed attenuation. This measures\napproximately 3.0 cm. There are associated indistinct calcifications confined\nto this asymmetry/mass.\n\nOn the left, there are several adjacent areas of nodular asymmetry in the\nupper breast, along the axis of the nipple, extending medially and laterally.\nThis measures approximately 5 cm in its widest/longest dimension. There are no\nassociated calcifications.\n\nBILATERAL BREAST ULTRASOUND: Right breast - There are regions of\nfibroglandular tissue from ___ o'clock at 5-7 cm FN. There is no mass or\nshadowing abnormality.\n\nOn the left, there are regions of fibroglandular tissue, specifically at 10,\n11, 12, 1 and 2 o'clock, at varying distances from the nipple but\ncorresponding to the region seen on mammography.", + "output": "Bilateral asymmetries likely represent areas of fibroglandular tissue.\nProbably benign calcifications in the right breast in the region of asymmetry.\n\nRECOMMENDATION:\n 6 month followup of both breasts to include magnification views on the right\nrecommend\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nFINDING: On the right, there is a circumscribed lobulated mass/asymmetry in\nthe upper-outer quadrant which is of mixed attenuation. This measures\napproximately 3.0 cm. There are associated indistinct calcifications confined\nto this asymmetry/mass.\n\nOn the left, there are several adjacent areas of nodular asymmetry in the\nupper breast, along the axis of the nipple, extending medially and laterally.\nThis measures approximately 5 cm in its widest/longest dimension. There are no\nassociated calcifications.\n\nBILATERAL BREAST ULTRASOUND: Right breast - There are regions of\nfibroglandular tissue from ___ o'clock at 5-7 cm FN. There is no mass or\nshadowing abnormality.\n\nOn the left, there are regions of fibroglandular tissue, specifically at 10,\n11, 12, 1 and 2 o'clock, at varying distances from the nipple but\ncorresponding to the region seen on mammography.", + "output": "Bilateral asymmetries likely represent areas of fibroglandular tissue.\nProbably benign calcifications in the right breast in the region of asymmetry.\n\nRECOMMENDATION:\n 6 month followup of both breasts to include magnification views on the right\nrecommend\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.The\nfocal asymmetry in the right upper outer breast with associated amorphous\ncalcifications and the focal asymmetry in the left upper inner breast are\nstable. Given three-year stability, these are consistent with benign\nfindings. No suspicious mass, architectural distortion, or suspicious grouped\nmicrocalcifications is appreciated in either breast.\n\nUltrasound was performed in the area of pain in the upper central right breast\nas indicated by the patient. No solid or cystic lesion is seen. Further\nmanagement of the patient's symptoms at this time should be based on the\nclinical assessment.", + "output": "Benign bilateral breast asymmetries. No focal mammographic or sonographic\nabnormality identified in the right breast in an area of pain as indicated by\nthe patient. Further management of the patient's symptoms at this time should\nbe based on the clinical assessment.\n\nRECOMMENDATION(S): Annual screening mammography. Clinical follow up.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 750 mL of clear yellow fluid were removed. Fluid samples\nwere submitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 750 mL of fluid were removed." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: A marker is placed in the vicinity of the lump by the patient. \nThere is no mammographic finding to correlate with the palpable lump. There\nis no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. There are postsurgical changes of reduction mammoplasty\nidentified.\n\nLeft breast: There is no dominant mass, architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted sonography of the area of symptomatology was\nperformed both supine and upright. No cystic, solid or shadowing findings are\nidentified in this region. Sonography demonstrated at ___ o'clock 3 cm from\nnipple in the area of. Areolar scar a tiny cyst which is likely an oil cyst\nmeasuring approximately 3 mm.", + "output": "No mammographic evidence of malignancy.\n\nMammographic or sonographic correlate to the palpable lump as directed by the\npatient.\n\nRECOMMENDATION(S): Continued clinical follow-up is recommended. Assuming\nthere is no change the patient should resume the annual screening schedule.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Grayscale, color, and spectral doppler imaging was obtained of the right and\nleft common femoral, femoral, and popliteal veins. Normal flow,\ncompressibility, augmentation, and waveforms are demonstrated. No intraluminal\nthrombus is identified. Normal color flow and compressibility are demonstrated\nin the posterior tibial and peroneal veins. There is normal respiratory\nvariation in both common femoral veins. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis in right or left lower extremity." + }, + { + "input": "RIGHT:\nCalcified plaque seen in the right carotid bulb and at the origin of the right\nICA.\nThe peak systolic velocity in the right common carotid artery is 124 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 83, 99, and 134 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 39 cm/sec.\nThe ICA/CCA ratio is 1.08.\nThe external carotid artery has peak systolic velocity of 236 cm/sec.\nDespite diligent effort the right vertebral artery could not be identified.\n\nLEFT:\nCalcified plaque is seen in the left carotid bulb and at the origin of the\nleft ICA.\nThe peak systolic velocity in the left common carotid artery is 127 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 96, 110, and 104 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 0.87.\nThe external carotid artery has peak systolic velocity of 148 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate stenosis (40-59%) of the right internal carotid artery.\n2. Right external carotid artery stenosis.\n3. Mild stenosis (less than 40%) of the left internal carotid artery." + }, + { + "input": "A 1.5 x 1.1 x 1.0 cm small hematoma is identified in the left groin, anterior\nto the left common femoral artery and vein. No pseudoaneurysm or arteriovenous\nfistula identified. Multiple normal-appearing inguinal lymph nodes\nidentified.", + "output": "No pseudoaneurysm present. A 1.5 cm hematoma is identified anterior to the\ncommon femoral vessels." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 5 mm circumscribed oval mass in the medial left breast at mid depth\nwhich persists on spot compression views. There are no associated\nmicrocalcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast in the area of\nmammographic mass at 9 o'clock, 8 cm from the nipple demonstrates a simple\ncyst measuring 4 mm x 3 mm x 4 mm, corresponding to the mammographic finding. \nThere is no suspicious mass or suspicious sonographic finding.", + "output": "Simple cyst corresponding to the mammographic mass in the left breast.\nNo mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a 5 mm circumscribed oval mass in the medial left breast at mid depth\nwhich persists on spot compression views. There are no associated\nmicrocalcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast in the area of\nmammographic mass at 9 o'clock, 8 cm from the nipple demonstrates a simple\ncyst measuring 4 mm x 3 mm x 4 mm, corresponding to the mammographic finding. \nThere is no suspicious mass or suspicious sonographic finding.", + "output": "Simple cyst corresponding to the mammographic mass in the left breast.\nNo mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a very small\namount ofascites. A suitable target in the deepest pocket in the left\nflankquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nUnder realtime guidance, a 20 gauge spinal needle was advanced into the fluid\nand 20 cc aspirated for diagnostic testing.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ the procedure.", + "output": "Successful small volume diagnostic paracentesis." + }, + { + "input": "Targeted ultrasound was performed in the bilateral retroareolar regions and in\nthe right breast from ___ o'clock 1-10 cm from the nipple and in the left\nbreast from ___ o'clock 1-10 cm from the nipple in the area of concern as\nindicated by the patient. No suspicious solid or cystic mass was identified. \nNormal breast tissue was identified.", + "output": "No suspicious findings in the area of concern in either breast. Clinical\nfollow-up is recommended.\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nTriangular shaped marker indicating area of pain in the upper outer left\nbreast is noted. There is no suspicious mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the area of clinical\nconcern as directed by the patient from the 12 to 3 o'clock positions which\nwas without any discrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy in either breast. No\nsonographic abnormality in the left breast areas of clinical concern. Any\ndecision for further intervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up, age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 103 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 103, 70, and 75 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 90 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 50, 75, and 60 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 70 cm/sec.\nThe ICA/CCA ratio is 0.87.\nThe external carotid artery has peak systolic velocity of 117 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "< 40% stenosis of the right internal carotid artery.\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "Targeted breast ultrasound was performed in area of previously documented\npapilloma with atypia.\n\nAt 11 o'clock, 7 cm from the nipple there is a 0.6 x 0.6 x 0.7 cm\ncircumscribed, lobulated hypoechoic mass with no significant posterior\nfeatures or internal vascularity, which corresponds to previously biopsied\nintraductal papilloma with atypia. Previously this mass measured 0.6 x 0.8 x\n0.8 cm in ___, which is stable, allowing for differences in\nmeasurement technique.", + "output": "Two year stability of previously biopsied intraductal papilloma with atypia in\nthe left breast.\n\nRECOMMENDATION(S): Diagnostic bilateral mammogram in ___.\n\nLeft breast ultrasound in ___.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient. She\nwas given information to schedule her follow-up.\n\nAdditionally, the patient was offered the opportunity to undergo diagnostic\nmammogram today, however she declined. She stated that she would prefer to\nundergo mammography in ___.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and somewhat\nnodular which may obscure detection of small masses. Best seen on CC\ntomosynthesis view, a circumscribed oval equal density mass measures 0.6 x 0.5\ncm in the medial slightly inferior right breast is identified. Although this\nwas not well appreciated on spot-compression views, further evaluation with\nultrasound was undertaken given the dense breast tissue. Biopsy clips are\nseen in the left breast corresponding to sites of previously biopsied\npapillomas. The mass adjacent to the coil clip which corresponds to the\npreviously biopsied intraductal papilloma with atypia is stable. This area\nwas further assessed with targeted ultrasound.\n\nUltrasound of the right breast from ___ o'clock 1-8 cm from the nipple\ncorresponding the area of concern on mammography was performed. At 3 o'clock\n5-6 cm from the nipple, there is an oval circumscribed hypoechoic mass without\nsignificant vascularity and slight through transmission measuring 0.6 x 0.3 x\n0.7 cm. This is felt to correspond to the mammographic finding. Options of\nfollowup imaging, ultrasound core biopsy and surgical excision were discussed\nwith the patient. Given that the mass does not appear to be previously\npresent, ultrasound-guided biopsy would be the preferred approach. However,\nthe patient would prefer to undergo follow-up imaging at this time.\n\nUltrasound of the left breast at 11 o'clock cm 7 from the nipple identified a\nstable 0.8 x 0.7 x 0.8 cm lobulated hypoechoic mass without dating back to\n___ allowing for differences in scanning technique. Therefore, given ___\nyears of stability, this is consistent with a benign finding despite the fact\nthat surgical excision had been recommended. As this is also mammographically\nvisible, this can be assessed on subsequent mammography.", + "output": "1. Probable benign mass in the right breast at 3 o'clock for which the patient\nhas opted for followup imaging in six months rather than biopsy, even though\nthe mass appears to have developed.\n2. Three year stability of the left breast mass at 11 o'clock corresponding to\npreviously biopsied intraductal papilloma with atypia. No further sonographic\nfollow up is necessary at this time. This can be assessed on subsequent\nmammography.\n\nRECOMMENDATION(S): Diagnostic right breast ultrasound in six months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and somewhat\nnodular which may obscure detection of small masses. Best seen on CC\ntomosynthesis view, a circumscribed oval equal density mass measures 0.6 x 0.5\ncm in the medial slightly inferior right breast is identified. Although this\nwas not well appreciated on spot-compression views, further evaluation with\nultrasound was undertaken given the dense breast tissue. Biopsy clips are\nseen in the left breast corresponding to sites of previously biopsied\npapillomas. The mass adjacent to the coil clip which corresponds to the\npreviously biopsied intraductal papilloma with atypia is stable. This area\nwas further assessed with targeted ultrasound.\n\nUltrasound of the right breast from ___ o'clock 1-8 cm from the nipple\ncorresponding the area of concern on mammography was performed. At 3 o'clock\n5-6 cm from the nipple, there is an oval circumscribed hypoechoic mass without\nsignificant vascularity and slight through transmission measuring 0.6 x 0.3 x\n0.7 cm. This is felt to correspond to the mammographic finding. Options of\nfollowup imaging, ultrasound core biopsy and surgical excision were discussed\nwith the patient. Given that the mass does not appear to be previously\npresent, ultrasound-guided biopsy would be the preferred approach. However,\nthe patient would prefer to undergo follow-up imaging at this time.\n\nUltrasound of the left breast at 11 o'clock cm 7 from the nipple identified a\nstable 0.8 x 0.7 x 0.8 cm lobulated hypoechoic mass without dating back to\n___ allowing for differences in scanning technique. Therefore, given ___\nyears of stability, this is consistent with a benign finding despite the fact\nthat surgical excision had been recommended. As this is also mammographically\nvisible, this can be assessed on subsequent mammography.", + "output": "1. Probable benign mass in the right breast at 3 o'clock for which the patient\nhas opted for followup imaging in six months rather than biopsy, even though\nthe mass appears to have developed.\n2. Three year stability of the left breast mass at 11 o'clock corresponding to\npreviously biopsied intraductal papilloma with atypia. No further sonographic\nfollow up is necessary at this time. This can be assessed on subsequent\nmammography.\n\nRECOMMENDATION(S): Diagnostic right breast ultrasound in six months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n56/11 cm/sec in its proximal portion, 70/20 cm/sec in its mid portion, and\n78/25 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n106/22 cm/sec.\nThe external carotid artery has peak systolic velocity of 85 cm/sec.\nThe vertebral artery has peak systolic velocity of 38 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 0.73.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n62/14 cm/sec in its proximal portion, 85/33 cm/sec in its mid portion, and\n98/31 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 89/26\ncm/sec.\nThe external carotid artery has peak systolic velocity of 80 cm/sec.\nThe vertebral artery has peak systolic velocity of 55 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.1.", + "output": "No atherosclerotic plaque identified. No internal carotid artery stenosis\npresent." + }, + { + "input": "BILATERAL BREAST ULTRASOUND: In the right axilla multiple enlarged lymph nodes\nhave lobular and thickened cortices but preserved fatty hila. The cortical\nthickness measures up to 4 mm. Compared to the prior study of ___,\nthe size of the lymph nodes and cortical thickness is not significantly\nchanged, but overall decreased from ___. The previously seen skin\nthickening is also not significantly changed from ___.\nUltrasound of the left axilla was performed and revealed similar appearing\nlymph nodes and skin thickening suggesting this represents a more systemic\nprocess, rather than a localized process to the right axilla.", + "output": "Interval improvement of right axillary skin thickening and lymphadenopathy\nsince ___ but stable since ___. Given the similar appearance of the\nleft axilla, this suggests that this is a systemic process, rather than a\nprocess localized to the right axilla. For this reason, no additonal\nultrasound follow-up is necessary at this time. Right axillary symptoms can\nbe managed clinically and an ultrasound may be performed if clinically\nnecessary.\nThe patient will be due for her annual mammogram in ___ and this\nwill be scheduled as a diagnostic exam, and special attention to the right\naxilla should be made at that time.\n\nRECOMMENDATION: The patient should return in 6 months for her annual\nmammogram. This will be scheduled as a diagnostic study.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The findings were discussed by Dr. ___ with ___ on the\ntelephone on ___ at 10:50 AM, 30 minutes after discovery of the\nfindings.\n\nBI-RADS: 2 Benign." + }, + { + "input": "SPLEEN: Normal echogenicity and vascularity. No suspicious masses or lesions.\n Spleen length: 7.1 cm", + "output": "Normal spleen." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of\n85/19 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n73/28 cm/sec in its proximal portion, 76/27 cm/sec in its mid portion and\n85/28 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 81cm/sec.\nThe vertebral artery has peak systolic velocity of 55 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.0..\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left common carotid artery had peak systolic/diastolic velocities of\n102/25 cm/sec.\nThe left internal carotid artery had peaks ystolic/diastolic velocities of\n57/21 cm/sec in its proximal portion, 68/24 cm/sec in its mid portion and\n79/29 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 96cm/sec.\nThe vertebral artery has peak systolic velocity of 46 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.77.", + "output": "No significant stenosis in either internal carotid artery." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 68 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 68 cm/s, 83 cm/s, and 56 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of69 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 65 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 67 cm/s, 89 cm/s, and 98 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 81 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Normal ultrasound of the right internal carotid artery.\n\nLess than 40% stenosis of the left internal carotid artery." + }, + { + "input": "There is normal compressibility, flow and augmentation of the bilateral common\nfemoral, proximal femoral, mid femoral, distal femoral and popliteal veins.\nNormal color flow and compressibility are demonstrated in the posterior tibial\nand peroneal veins. There is normal respiratory variation in the common\nfemoral veins bilaterally.", + "output": "No evidence of deep vein thrombosis in the bilateral lower extremities..\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 4:45PM, 5 minutes after discovery of the\nfindings." + }, + { + "input": "There is normal respiratory variation in both common femoral veins. There is\nnormal compressibility and augmentation of biltateral common femoral, femoral,\npopliteal, posterior tibial and peroneal veins. No ___ cyst is seen.", + "output": "No evidence of deep vein thrombosis to the popliteal level..\n\nNOTIFICATION: Per ordering physician request, these findings were\ncommunicated to Dr. ___ by Dr. ___ telephone at 15:18 on ___ upon review of the images." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of amber-colored fluid was removed. Fluid samples were\nsubmitted to the laboratory for cell count, differential, and culture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis, yielding 2 L of amber-colored ascitic fluid. Fluid samples were\nsubmitted to the laboratory for cell count, differential and culture." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The medial pole of the right lower quadrant transplant kidney was\ntargeted and 2 biopsy passes performed.\n\nSEDATION: Moderate sedation was not administered.", + "output": "Ultrasound guidance for percutaneous right lower quadrant transplant kidney\nbiopsy." + }, + { + "input": "The right iliac fossa transplant renal morphology is normal. Specifically,\nthe cortex is of normal thickness and echogenicity, pyramids are normal, there\nis no urothelial thickening, and renal sinus fat is normal. There is no\nhydronephrosis and no perinephric fluid collection.\n\nThe resistive index of intrarenal arteries ranges from 0.75 to 0.76, within\nthe normal range. The main renal artery shows a normal waveform, with prompt\nsystolic upstroke and continuous antegrade diastolic flow, with peak systolic\nvelocity of 139. Vascularity is symmetric throughout transplant, however in\nthe lower pole there is vascular structure which demonstrates both arterial\nand venous waveforms possibly representing an AV fistula. The transplant\nrenal vein is patent and shows normal waveform.\n\nThe bladder contains a Foley catheter. No echogenic clot is detected within\nthe bladder.", + "output": "1. In the lower pole of the renal transplant, there is a vascular structure\ndemonstrating both arterial and venous wave forms possibly representing an AV\nfistula.\n2. The bladder contains a Foley catheter, however no clot is visualized within\nthe underdistended bladder." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the transplant kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was not administered.", + "output": "Ultrasound guidance for percutaneous right lower quadrant transplant kidney\nbiopsy." + }, + { + "input": "Successful ultrasound-guided placement of 8 ___ pigtail catheter in the\ngallbladder, with aspiration of 100 cc, cloudy, bilious fluid.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the 6 o'clock position of the right breast underlying the palpable marker\nthere is an asymmetry measuring 35 mm in greatest dimension. There are few\npunctate calcifications within the asymmetry, however they are not grouped. \nThere is no architectural distortion or spiculated mass seen in the left\nbreast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast in the area\npalpable concern as indicated by the patient at 6 o'clock, 3 cm from the\nnipple demonstrates an ill-defined hypoechoic mass which is heterogeneous and\ndifficult to determine exact margins. Best attempts at measurement\ndemonstrates an area measuring 23 mm x 10 mm by 18 mm. Ultrasound-guided core\nbiopsy is recommended. Additionally, there are numerous cysts seen in the\nright breast. The largest simple cyst is at 9 o'clock, 1 cm from the nipple\nmeasuring 6 mm x 4 mm by 9 mm and a larger cyst with layering debris at 9\no'clock 1 cm from the nipple measuring 8 mm by 8 mm x 8 mm.", + "output": "Ill-defined hypoechoic mass corresponding to the palpable area of concern in\nthe right breast for which ultrasound-guided core biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy right breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Results recommendations were called to the patient's primary care\nphysician, ___, MD at 14:44. The patient underwent same-day biopsy.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Mass in the right breast at 6 o'clock 3 cm from the nipple. A 3.6 cm abnormal\narea was noted and the spiculated mass was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.. The procedure was performed by ___. ___,\nM.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous clip was deployed under ultrasound guidance. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and MLO views were obtained and the clip is in\nappropriate position in the right retroareolar central breast..", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Mass in the right breast at 6 o'clock 3 cm from the nipple. A 3.6 cm abnormal\narea was noted and the spiculated mass was targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.. The procedure was performed by ___. ___,\nM.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous clip was deployed under ultrasound guidance. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and MLO views were obtained and the clip is in\nappropriate position in the right retroareolar central breast..", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Targeted sonographic examination of the right axilla was performed with\nattention to the area of clinical concern as denoted by the patient. She\nreports fullness in the region of axillary surgery. Expected postsurgical\nchanges are noted. There are a few apparent surgical clips seen in this\nregion. No suspicious cystic or solid mass is noted.", + "output": "Expected postsurgical changes in the area of clinical concern, without\nsuspicious sonographic abnormality.\n\nRECOMMENDATION(S): Clinical followup for any clinical findings. Patient is\nalso due for left breast mammography in ___.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\n2 core biopsy samples were obtained and placed in formalin. The skin was then\ncleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 75 mcg fentanyl throughout the total intra-service time of 20\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "BILATERAL BREAST ULTRASOUND: US FINDING\n\nLEFT BREAST: Targeted ultrasound was performed on the left breast in the area\nof patient's tenderness. In the 12 o'clock to 3 o'clock region of the left\nbreast spanning approximately 1-10 cm from the nipple, there was no evidence\nof any discrete suspicious solid or cystic masses. There is a hypoechoic area\nin the 2 o'clock region which extends to the skin, compatible with normal\nappearing surgical scar. Targeted ultrasound of the left axilla did not\ndemonstrate any abnormal appearing lymph nodes.\n\nRIGHT BREAST:\nTargeted ultrasound was performed in the right reconstruct breast in the\npalpable area of patient's concern. At 1 o'clock approximately 12 cm from the\nnipple, there is a heterogeneous predominantly hypoechoic mass measuring 0.5 x\n0.6 x 0.4 cm without evidence of internal vascularity or suspicious posterior\nfeatures. While this may represent fat necrosis, the sonographic features are\nindeterminate. A BB marker was placed and attempts were made at obtaining\nmammographic images.\n\nRIGHT BREAST DIAGNOSTIC MAMMOGRAM:\nLimited views of the reconstructed breast demonstrate surgical clips in the\naxilla from prior axillary lymph node dissection. The area of concern was\nunable to be imaged due to the far superior medial location. There is no\ndominant mass, suspicious grouped microcalcifications or unexplained\narchitectural distortion.", + "output": "1. Indeterminate mass in the right reconstructed breast corresponding to the\narea of concern which may represent fat necrosis but for which confirmation\nwith tissue sampling is recommended.\n2. Expected postsurgical changes in the left breast, without evidence of\nsuspicious sonographic abnormality.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of mass in the reconstructed\nright breast\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 12:06 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "BILATERAL BREAST ULTRASOUND: US FINDING\n\nLEFT BREAST: Targeted ultrasound was performed on the left breast in the area\nof patient's tenderness. In the 12 o'clock to 3 o'clock region of the left\nbreast spanning approximately 1-10 cm from the nipple, there was no evidence\nof any discrete suspicious solid or cystic masses. There is a hypoechoic area\nin the 2 o'clock region which extends to the skin, compatible with normal\nappearing surgical scar. Targeted ultrasound of the left axilla did not\ndemonstrate any abnormal appearing lymph nodes.\n\nRIGHT BREAST:\nTargeted ultrasound was performed in the right reconstruct breast in the\npalpable area of patient's concern. At 1 o'clock approximately 12 cm from the\nnipple, there is a heterogeneous predominantly hypoechoic mass measuring 0.5 x\n0.6 x 0.4 cm without evidence of internal vascularity or suspicious posterior\nfeatures. While this may represent fat necrosis, the sonographic features are\nindeterminate. A BB marker was placed and attempts were made at obtaining\nmammographic images.\n\nRIGHT BREAST DIAGNOSTIC MAMMOGRAM:\nLimited views of the reconstructed breast demonstrate surgical clips in the\naxilla from prior axillary lymph node dissection. The area of concern was\nunable to be imaged due to the far superior medial location. There is no\ndominant mass, suspicious grouped microcalcifications or unexplained\narchitectural distortion.", + "output": "1. Indeterminate mass in the right reconstructed breast corresponding to the\narea of concern which may represent fat necrosis but for which confirmation\nwith tissue sampling is recommended.\n2. Expected postsurgical changes in the left breast, without evidence of\nsuspicious sonographic abnormality.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of mass in the reconstructed\nright breast\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 12:06 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Mass in the right reconstructed breast at 1 o'clock 12 cm from the nipple.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.. The procedure was performed by V. ___,\nM.D.(Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion and 3\ncores were obtained using a 14-gauge ___ biopsy device. \nNext, a percutaneous clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: Postprocedure mammogram was not performed due to the\nextreme medial location of the mass, this was not seen on mammography.", + "output": "Technically successful US-guided core biopsy of the mass in the right\nreconstructed breast. Pathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. No change is seen when compared to prior exams.\n\nBREAST ULTRASOUND: Scanning of the upper-outer quadrant in the area of\nsymptomatology shows no mass or shadowing abnormality.", + "output": "No mammographic change to indicate malignancy. No ultrasound abnormality in\nthe area of the patient's symptoms.\n\nRECOMMENDATION(S): Clinical followup. Routine screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque in\nthe right internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 106 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 100, 90, and 67 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 0.94.\nThe external carotid artery has peak systolic velocity of 174 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 116 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 68, 76, and 82 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 129 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Mild heterogeneous atherosclerotic plaque within the right internal\ncarotid artery.\n2. No hemodynamically significant stenosis within the carotid vasculature,\nbilaterally." + }, + { + "input": "The aorta measures 1.8 cm in the proximal portion, 1.7 cm in mid portion and\n1.7 cm in the distal abdominal aorta. The aorta is partially calcified\nhowever no aneurysm is visualized. Wall-to-wall color flow is seen within\naorta.\n\nThe right common iliac artery measures 1.0 cm and the left common iliac artery\nmeasures 1.3 cm.\n\nThe right kidney measures about 10.5 cm and the left kidney measures about 9.1\ncm. There is no hydronephrosis. A simple cortical cyst in the right kidney\nmeasures 1.2 x 1.0 cm. A simple cyst at the upper pole of the left kidney\nmeasures 3.1 x 3.2 cm and a simple cortical cyst at the lower pole of the left\nkidney measures 1.4 x 1.1 cm.", + "output": "1. Atherosclerotic aorta however no aneurysm is visualized.\n2. Simple bilateral renal cysts are incidentally noted." + }, + { + "input": "RIGHT AXILLARY ULTRASOUND: Targeted ultrasound was performed in the palpable\narea of concern as indicated by the patient in the right axilla. There is a\nrelatively circumscribed heterogeneously hypoechoic lesion with extension into\nthe dermis measuring 0.9 x 0.9 x 0.5 cm but no abnormal vascularity. This is\nmost likely to represent a benign lesion such as an epidermal inclusion cyst.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of pain\nas indicated by the patient in the left retroareolar region. There is dense\nbreast parenchyma without suspicious solid or cystic masses.", + "output": "1. Probable epidermal inclusion cyst corresponding to the palpable area of\nconcern in the right axilla.\n2. No imaging abnormality to explain the patient's left nipple pain.\n\nRECOMMENDATION(S): Clinical followup is recommended for the patient's pain. \nIf the right axillary lesion remains asymptomatic, no specific followup is\nnecessary.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nSkin markers delineate areas of focal pain within both the right and left\nbreast. There is a partially obscured 1.4 cm oval mass within inner and\nslightly upper left breast posterior depth which appears to correlate to 1 of\nthe marked areas of pain in the left breast. There is no additional dominant\nmass, architectural distortion, or suspicious grouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasounds at site of pain 10:00 position\nleft breast 8 cm from the nipple demonstrates a 1.2 x 0.5 x 1.2 cm oval\ncircumscribed mass with posterior acoustic enhancement and no significant\ninternal color flow. Imaging characteristics favor a benign fibroadenoma. \nTargeted ultrasound of the outer central left breast in the area of clinical\nconcern was unremarkable.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasounds at the additional sites of pain\nwithin the right breast demonstrate normal tissue without cystic or solid\nmass.", + "output": "1.2 cm mass at the 10 o'clock position left breast 8 cm from the nipple which\ncorresponds to 1 of the sites of focal pain. Imaging characteristics favor a\nprobably benign mass such as a fibroadenoma. After discussing risks and\nbenefits of surveillance versus biopsy, the patient has requested biopsy.\n\nNo mammographic or sonographic Findings to account for additional areas of\npain within the right and left breast. Clinical follow-up is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy left breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. The findings were communicated to ___, N.P. by ___\n___, M.D. by email on ___ at 12:58 pm.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nSkin markers delineate areas of focal pain within both the right and left\nbreast. There is a partially obscured 1.4 cm oval mass within inner and\nslightly upper left breast posterior depth which appears to correlate to 1 of\nthe marked areas of pain in the left breast. There is no additional dominant\nmass, architectural distortion, or suspicious grouped microcalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasounds at site of pain 10:00 position\nleft breast 8 cm from the nipple demonstrates a 1.2 x 0.5 x 1.2 cm oval\ncircumscribed mass with posterior acoustic enhancement and no significant\ninternal color flow. Imaging characteristics favor a benign fibroadenoma. \nTargeted ultrasound of the outer central left breast in the area of clinical\nconcern was unremarkable.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasounds at the additional sites of pain\nwithin the right breast demonstrate normal tissue without cystic or solid\nmass.", + "output": "1.2 cm mass at the 10 o'clock position left breast 8 cm from the nipple which\ncorresponds to 1 of the sites of focal pain. Imaging characteristics favor a\nprobably benign mass such as a fibroadenoma. After discussing risks and\nbenefits of surveillance versus biopsy, the patient has requested biopsy.\n\nNo mammographic or sonographic Findings to account for additional areas of\npain within the right and left breast. Clinical follow-up is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy left breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. The findings were communicated to ___, N.P. by ___\n___, M.D. by email on ___ at 12:58 pm.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the left breast at 10 o'clock 8 cm from the nipple there is a 1.2 x 0.5 x\n1.1 cm hypoechoic oval well-circumscribed mass.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, MD (___). The procedure was supervised byE.\n___, M.D. (attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm the clip at the margin\nof the mammographic finding in the inner upper left breast at posterior depth.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\nor the radiology department in ___ business days. Standard post care\ninstructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the left breast at 10 o'clock 8 cm from the nipple there is a 1.2 x 0.5 x\n1.1 cm hypoechoic oval well-circumscribed mass.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, MD (___). The procedure was supervised byE.\n___, M.D. (attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm the clip at the margin\nof the mammographic finding in the inner upper left breast at posterior depth.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\nor the radiology department in ___ business days. Standard post care\ninstructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "I scanned the entire upper outer quadrant with negative results. Represents\nto pictures were taken demonstrating normal glandular breast tissue. No\ncystic, solid or shadowing findings were identified.", + "output": "No abnormality in the right upper outer quadrant.\n\nRECOMMENDATION(S): Continued clinical follow-up of the patient's symptoms\nrecommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The aorta measures 2.4 cm in the proximal portion, and 2.2 cm in mid portion. \nAgain there is fusiform dilation of the distal aorta measuring 3 x 3.6 cm (AP\nx TRV), unchanged from the prior study (image 9).\n\nThere is severe calcified atherosclerotic plaque. Wall-to-wall color flow is\nseen within the aorta with appropriate arterial waveforms. The right common\niliac artery measures 1.5 cm and the left common iliac artery measures 1.6 cm,\nessentially unchanged.\n\nThe right kidney measures 10.6 cm and the left kidney measures 11.8 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "Tortuous calcified aorta with unchanged 3 cm aneurysm of the distal portion" + }, + { + "input": "The aorta measures 2.5 x 1.9 cm in the proximal portion, 2.2 x 2.8 cm in mid\nportion. Re-demonstrated is fusiform dilatation of the distal abdominal aorta\nmeasuring 3.1 x 3.6 cm. The distal abdominal aorta previously measured 3.0 x\n3.6 there is severe calcified atherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.5 cm and the left common iliac artery\nmeasures 1.2 cm.\n\nThe right kidney measures 9.7 cm and the left kidney measures 11.1 cm. Limited\nviews of the kidneys are unremarkable without hydronephrosis.", + "output": "Tortuous calcified aorta with unchanged, aneurysmal portion of the distal\naorta." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the left hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 3 18-gauge core biopsy passes were made. \nThe sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n10 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 3, with specimen sent to\npathology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of\n57/12 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n53/16 cm/sec in its proximal portion, 73/15 cm/sec in its mid portion and\n67/24 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 65cm/sec.\nThe vertebral artery has peak systolic velocity of 48 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.2.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left common carotid artery had peak systolic/diastolic velocities of 94/17\ncm/sec.\nThe left internal carotid artery had peak systolic/diastolic velocities of\n76/15 cm/sec in its proximal portion, 82/22 cm/sec in its mid portion and\n99/35 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 64cm/sec.\nThe vertebral artery has peak systolic velocity of 42 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.0.", + "output": "Less than 40% stenosis of bilateral internal carotid arteries. Normal\nantegrade flow in the vertebral arteries." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is a 4 mm circumscribed oval mass in the upper outer left breast at\nposterior depth. There are no associated calcifications or distortions. \nAdditional areas of nodularity are unchanged.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper-outer left breast was\nperformed. At 2:00 position 12 cm from the nipple there is an oval parallel\ncircumscribed hypoechoic mass measuring 5 x 2 x 4 mm, corresponding to the\nmass seen on the mammogram.", + "output": "There is a probably benign mass in the upper-outer left breast, likely\nminimally complicated cyst, for which six-month follow-up diagnostic mammogram\nand ultrasound is recommended to document expected stability.\n\nRECOMMENDATION(S): Diagnostic mammogram and ultrasound of the left breast in\n6 months.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is a 4 mm circumscribed oval mass in the upper outer left breast at\nposterior depth. There are no associated calcifications or distortions. \nAdditional areas of nodularity are unchanged.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper-outer left breast was\nperformed. At 2:00 position 12 cm from the nipple there is an oval parallel\ncircumscribed hypoechoic mass measuring 5 x 2 x 4 mm, corresponding to the\nmass seen on the mammogram.", + "output": "There is a probably benign mass in the upper-outer left breast, likely\nminimally complicated cyst, for which six-month follow-up diagnostic mammogram\nand ultrasound is recommended to document expected stability.\n\nRECOMMENDATION(S): Diagnostic mammogram and ultrasound of the left breast in\n6 months.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are multiple stable similar and benign-appearing masses within both\nbreasts some of which have associated coarse calcifications consistent with a\nbenign process. The previously described 4 mm circumscribed oval mass within\nthe upper outer left breast posterior depth has decreased in size and density\ncompared to the prior mammogram currently measuring approximately 2 mm. This\nwas again further evaluated with ultrasounds. There is no new dominant mass,\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound 2 o'clock left breast 12 cm from the\nnipple again demonstrates an avascular hypoechoic oval circumscribed mass\ncurrently measuring 0.3 x 0.2 x 0.2 cm which is smaller compared to the prior\nstudy consistent with a benign process.", + "output": "No mammographic evidence of malignancy within either breast.\n\nInterval decrease in size of mass 2 o'clock left breast 12 cm from the nipple\nconsistent with a benign process.\n\nRECOMMENDATION(S): The patient may resume age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC RIGHT MAMMOGRAM WITH CAD:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: The right lateral sternum was evaluated. At 4\no'clock 14 cm from the nipple immediately adjacent to the sternum there is a\n1.2 x 0.9 x 0.5 cm avascular hypoechoic area with a bright hyperechoic focus\ncontained within it. On real-time scanning this central echogenicity has the\nappearance of suture material and extends to the sternum on oblique imaging. \nThis correlates with a piece of suture extending the on the sternum on the CT\nof the chest from ___ (02:24). Likely the hypoechoic area\nrepresents scarring. No additional findings are noted in the areas of\nclinical concern all along the right lateral sternal border.\n\nThe right inner central breast was scanned with special attention paid to 3\no'clock 5 cm from the area lower border, approximately 7-8 cm from the nipple,\nand no abnormality was identified.", + "output": "1. Diffuse pain along the right lateral sternal border without acute\nultrasound correlate.\n\n2. No imaging correlate for the area of clinical concern as indicated by the\nphysician in the right inner breast.\n\nRECOMMENDATION: Further management for the areas of clinical concern in the\nright breast should be based on the clinical assessment. Age and risk\nappropriate mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy via interpreter.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC RIGHT MAMMOGRAM WITH CAD:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: The right lateral sternum was evaluated. At 4\no'clock 14 cm from the nipple immediately adjacent to the sternum there is a\n1.2 x 0.9 x 0.5 cm avascular hypoechoic area with a bright hyperechoic focus\ncontained within it. On real-time scanning this central echogenicity has the\nappearance of suture material and extends to the sternum on oblique imaging. \nThis correlates with a piece of suture extending the on the sternum on the CT\nof the chest from ___ (02:24). Likely the hypoechoic area\nrepresents scarring. No additional findings are noted in the areas of\nclinical concern all along the right lateral sternal border.\n\nThe right inner central breast was scanned with special attention paid to 3\no'clock 5 cm from the area lower border, approximately 7-8 cm from the nipple,\nand no abnormality was identified.", + "output": "1. Diffuse pain along the right lateral sternal border without acute\nultrasound correlate.\n\n2. No imaging correlate for the area of clinical concern as indicated by the\nphysician in the right inner breast.\n\nRECOMMENDATION: Further management for the areas of clinical concern in the\nright breast should be based on the clinical assessment. Age and risk\nappropriate mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy via interpreter.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight Breast:\nA BB was placed with the palpable area in the right breast. There is no\ndiscrete mass underlying the BB. Ultrasound was performed for further\nevaluation. There is no other dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications. There is no significant\nchange.\n\nBREAST ULTRASOUND : Targeted ultrasound of the right breast was performed. \nThe right breast was scanned over the palpable area at 4 o'clock 5 cm from the\nnipple and no discrete solid or cystic mass was seen.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION: Final disposition of palpable area should be based on\nclinical evaluation.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight Breast:\nA BB was placed with the palpable area in the right breast. There is no\ndiscrete mass underlying the BB. Ultrasound was performed for further\nevaluation. There is no other dominant mass, unexplained architectural\ndistortion or suspicious grouped microcalcifications. There is no significant\nchange.\n\nBREAST ULTRASOUND : Targeted ultrasound of the right breast was performed. \nThe right breast was scanned over the palpable area at 4 o'clock 5 cm from the\nnipple and no discrete solid or cystic mass was seen.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION: Final disposition of palpable area should be based on\nclinical evaluation.\n\nNOTIFICATION: Findings communicated to the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Technically successful ultrasound-guided drainage of right lower quadrant\nabscess and catheter placement. No immediate postprocedure complication.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. 50 mL of pus was aspirated. Samples was sent for microbiology\nevaluation." + }, + { + "input": "Ultrasound evaluation of the proximal left thigh demonstrates an ill-defined\nregion of hypoechogenicity just lateral to the superficial femoral vessels,\nwhich likely corresponds to the finding on prior MRI.", + "output": "Only trace amounts of serosanguineous fluid was aspirated from an ill-defined\nhypoechogenic collection in the proximal left thigh, which was likely mostly\nphlegmonous. The sample was sent for microbiological evaluation." + }, + { + "input": "Tissue density: The breast tissue is almost entirely fatty.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast.\n\nBREAST ULTRASOUND:\nTargeted ultrasound exam of the left breast was performed in area of clinical\nconcern. No discrete solid or cystic mass is identified.", + "output": "No mammographic or sonographic correlate to patient's left breast pain.\n\nRECOMMENDATION: Further management of this patient should be based on\nclinical assessment at this time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe asymmetry in the superficial lateral breast persists with additional\nimaging and has increased in prominence compared to ___. This was\nfurther evaluated by ultrasound. There is no suspicious grouped\nmicrocalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the lateral breast in\nthe area of concern on mammography. At 3 o'clock 2 cm from nipple there is a\nsubtle 0.5 x 0.2 x 0.6 cm parallel hypoechoic mass with slightly irregular\nmargins without significant internal vascularity which corresponds to the\nmammographic finding.", + "output": "Indeterminate mass in the left breast. Ultrasound-guided biopsy is\nrecommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the left breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 13:07 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe asymmetry in the superficial lateral breast persists with additional\nimaging and has increased in prominence compared to ___. This was\nfurther evaluated by ultrasound. There is no suspicious grouped\nmicrocalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the lateral breast in\nthe area of concern on mammography. At 3 o'clock 2 cm from nipple there is a\nsubtle 0.5 x 0.2 x 0.6 cm parallel hypoechoic mass with slightly irregular\nmargins without significant internal vascularity which corresponds to the\nmammographic finding.", + "output": "Indeterminate mass in the left breast. Ultrasound-guided biopsy is\nrecommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the left breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\n The impression and recommendation above was entered by Dr. ___ on\n___ at 13:07 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "At 3 o'clock, 2 cm from the nipple in the left breast, a 0.6 x 0.3 x 0.5 cm\nhypoechoic mass with slightly irregular margins without internal vascularity\nwas again seen and targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P., ___, M.D.. The procedure was\nsupervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous clip was deployed under ultrasound guidance. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: The patient tolerated the procedure well and had a small <2 cm\nhematoma.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "At 3 o'clock, 2 cm from the nipple in the left breast, a 0.6 x 0.3 x 0.5 cm\nhypoechoic mass with slightly irregular margins without internal vascularity\nwas again seen and targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P., ___, M.D.. The procedure was\nsupervised by ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous clip was deployed under ultrasound guidance. The needle was\nremoved and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: The patient tolerated the procedure well and had a small <2 cm\nhematoma.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal atherosclerotic plaque at the level\nof the proximal internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 70 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 94, 80, and 70 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has minimal atherosclerotic plaque at the level\nof the proximal internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 65, 76, and 39 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 100 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No significant carotid arterial stenosis or plaque." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: There are scattered areas of fibroglandular density. Post\ntreatment changes are stable. Just medial to the lumpectomy site there is a 7\nmm asymmetry that does not change position on the rolled views suggesting it\nis in the central breast. However, no correlate on the oblique was identified.\nMultiple masses in the right central breast, best appreciated on the MLO view\nare stable and were previously shown to be cysts.\n\nLEFT BREAST ULTRASOUND: The entire inner left breast was scanned but focused\non the 9 o'clock location. At 9 o'clock 2 cm from the nipple there is a 0.4 x\n0.3 x 0.5 cm circumscribed anechoic mass with posterior acoustic enhancement\nand no internal vascularity that is consistent with a simple cyst.", + "output": "Stable left breast post treatment changes without evidence for malignancy in\neither breast.\n\nRECOMMENDATION: Annual mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: There are scattered areas of fibroglandular density. Post\ntreatment changes are stable. Just medial to the lumpectomy site there is a 7\nmm asymmetry that does not change position on the rolled views suggesting it\nis in the central breast. However, no correlate on the oblique was identified.\nMultiple masses in the right central breast, best appreciated on the MLO view\nare stable and were previously shown to be cysts.\n\nLEFT BREAST ULTRASOUND: The entire inner left breast was scanned but focused\non the 9 o'clock location. At 9 o'clock 2 cm from the nipple there is a 0.4 x\n0.3 x 0.5 cm circumscribed anechoic mass with posterior acoustic enhancement\nand no internal vascularity that is consistent with a simple cyst.", + "output": "Stable left breast post treatment changes without evidence for malignancy in\neither breast.\n\nRECOMMENDATION: Annual mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Right common carotid artery: The carotid bifurcation is well visualized. \nSignificant tortuosity of the mid cervical internal carotid artery is noted. \nThere is no evidence of atherosclerotic stenosis at the carotid bifurcation. \nIntracranial views: The distal internal carotid artery, right middle cerebral,\nand right anterior cerebral arteries are well visualized. Major branches of\nthe external carotid are also well visualized on this injection. Vessel\ncaliber smooth and tapering. The previously demonstrated internal carotid\nartery ophthalmic segment aneurysm appears completely occluded. A pipeline\nembolization device may be seen within the carotid siphon overlying the prior\nlocation of this lesion. No new aneurysm or vascular malformation is seen. \nThe posterior communicating artery is patent. The venous phase is\nunremarkable.\n\nLeft common carotid artery: The carotid bifurcation is well visualized. No\nevidence of atherosclerotic stenosis. Intracranial views: The distal internal\ncarotid, anterior cerebral, middle cerebral, and major branches of the\nexternal carotid arteries are well visualized. Vessel caliber is smooth and\ntapering without evidence of atherosclerosis. A pipeline embolization device\nis present through the cavernous segment of the left internal carotid artery\nthe region of the previously noted large cavernous aneurysm. Persistent\nfilling of the aneurysm beyond the lumen of the pipeline stent is noted,\nalthough significant stasis and involution of the lumen of the aneurysm has\noccurred. No new aneurysm or vascular malformation is seen. The venous phase\nis unremarkable.\n\nLeft vertebral artery: The left vertebral artery originates from the aortic\narch. This is a normal variant. The distal left vertebral, basilar, and\nbilateral posterior cerebral arteries are well visualized. Color artery and\nposterior cerebral arteries originate from a common trunk at the basilar apex.\nThere is posterior to anterior flow across a patent left posterior\ncommunicating artery. No new aneurysm or vascular malformation is seen. The\nvenous phase is unremarkable.\n\nRight common femoral artery: The sheath enters at the common femoral\nbifurcation. Vessel for is appropriate for Angio-Seal.", + "output": "Complete occlusion of the right para ophthalmic aneurysm.\n\nPersistent filling of left cavernous segment aneurysm.\n\nNo new aneurysm or vascular malformation.\n\nNo evidence of stent thrombosis to suggest an etiology of the patient's recent\nischemic stroke\n\nRECOMMENDATION(S): Will present case at upcoming cerebrovascular conference\nfor discussion on persistently filling cavernous aneurysm. Otherwise,\nfollowup per imaging routine." + }, + { + "input": "Targeted grayscale ultrasound images within the right lower quadrant showed\nperistalsis of bowel loops, and the appendix was not visualized. No fluid\ncollections or abnormalities are noted at the patient's site of pain.", + "output": "Nonvisualization of the appendix." + }, + { + "input": "Right breast ultrasound: Targeted ultrasound right breast was performed. The\nright breast was scanned at 10 o'clock underlying the palpable areas at 3 cm\nand 8 cm from the nipple and no discrete solid or cystic mass was seen. \nNormal fibroglandular tissue is noted.\nLeft breast ultrasound: Targeted ultrasound left breast was performed\nunderlying the palpable area felt by the patient's physician. The left breast\nwas scanned at 12 o'clock 9 cm from the nipple and no discrete solid or cystic\nmasses seen. Normal fibroglandular tissue was noted.", + "output": "Unremarkable targeted bilateral breast ultrasound with no ultrasound correlate\nto the palpable findings.\n\nRECOMMENDATION: Final disposition of the palpable area should be based on\nclinical evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 1 Negative." + }, + { + "input": "In the area of pain at 6 to 7:00 position 5-10 cm from the nipple, no\nsuspicious solid or cystic masses were seen. At 10:00 position 8 cm from the\nnipple there is a 13 mm enlarged intramammary lymph node with thickened\ncortex. Ultrasound of the right axilla was then performed. 1 of right\naxillary lymph nodes has top normal cortical thickness of 3 mm with the rest\nof visualized right axillary lymph nodes appearing normal. For comparison,\nleft axilla was also scanned. Visualized left axillary lymph nodes appear\nnormal.", + "output": "No fluid collection in the area of pain in the upper-outer right breast. \nThere is an enlarged intramammary lymph node at 10:00 position 8 cm from the\nnipple and a top-normal right axillary lymph node. These lymph nodes are most\nlikely reactive due to infection in the right breast, which is clinically\nimproving.\n\nRECOMMENDATION(S): Very short-term interval follow-up is recommended in 3\nweeks with targeted ultrasound of the right breast to document expected\ndecrease in size of an intramammary lymph node at 10:00 position right breast\nand top-normal right axillary lymph node. Close interval follow-up is also\nrecommended. If patient's symptoms do not improve or worsen, then repeat\nultrasound is recommended sooner.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound 10 o'clock right breast 8 cm from the nipple again\ndemonstrates an intramammary lymph node which is slightly less prominent\ncompared to the prior study, measuring 1.0 x 0.5 x 1.2 cm with decrease in\ncortical thickness, consistent with improving reactive lymph node.\n\nTargeted ultrasound right axilla again demonstrates a morphologically normal\nlymph node with cortex measuring less than 3 mm on today's examination again\nconsistent with improving reactive lymph node.", + "output": "Interval decrease in size/cortical thickness of intramammary and right\naxillary lymph node compatible with improving reactive lymph nodes in the\nsetting of recent mastitis. Findings are consistent with a benign process.\n\nRECOMMENDATION(S): Clinical follow-up of the right breast symptoms.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 97 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 66, 79, and 100 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 42 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 78 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 67, 81, and 101 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 57 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No significant plaque. Essentially normal carotid duplex. Normal vertebral\nflow." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 57 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 39 cm/s, 61 cm/s, and 48 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of46 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 50 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 33 cm/s, 64 cm/s, and 61 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 52 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the right internal carotid artery.\nNormal left internal carotid artery." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the anterior\nabdominal wall was performed. The lesion for biopsy was identified in the\ninferior aspect of the right rectus abdominis muscle. A suitable approach for\ntargeted biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues were anesthetized\nwith 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, two 18-gauge core biopsy samples were\nobtained. The samples were placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: None.", + "output": "Uncomplicated 18-gauge targeted biopsy x 2 of the right rectus muscle\nabdominus mass, with specimen sent to pathology." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 2 18-gauge core biopsy passes were made.\nThe sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 15\nmg Versed and 37.5 mcg fentanyl throughout the total intra-service time of \nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to\npathology." + }, + { + "input": "Enlarged, hypoechoic right inguinal lymph nodes.", + "output": "Technically successful ultrasound-guided core needle biopsy of right inguinal\nlymphadenopathy." + }, + { + "input": "The uterus is normal, measuring 9.0 x 3.4 x 2.3 cm. Endometrium is normal,\nmeasuring 3 mm. An IUD is positioned low in the uterus, with its upper cross\nbar projecting in the lower uterine segment. The IUD stem extends into the\ncervix. The left ovary is normal size with normal vascular waveforms. The\nright ovary is not identified but there is no large right adnexal mass. There\nis trace simple free fluid.", + "output": "1. Malpositioned IUD positioned low in the uterus extending into the cervical\ncanal.\n2. Normal left ovary with normal vascular waveform." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 52 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 74, 72, and 74 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 76 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left ICA stent is patent. Mild homogeneous plaque is identified in the\nleft internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 55 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 92, 96, and 76 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 33 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 217 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Patent left ICA stent. Mild homogeneous plaque in the left ICA results in\nless than 40% stenosis.\n\n2. No right-sided carotid vasculature atherosclerotic disease." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nThere is a circumscribed oval mass in the right upper outer quadrant. Without\nassociated calcifications or distortion. This on same day ultrasound\ncorresponds to a 5 mm circumscribed hypoechoic mass in the 10 o'clock which\ncould represent a complicated cyst.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned. In the 10 o'clock 5 cm from the nipple\nthere is an oval circumscribed hypoechoic mass which measures 0.5 by 0.2 x 0.5\ncm and demonstrates no internal vascularity and good through transmission.\nThis corresponds to the mammographic finding and could represent a complicated\ncyst and less likely a solid mass.", + "output": "Benign-appearing 5 mm mass in the right breast 10 o'clock which could\nrepresent either a complicated cyst or a solid mass.\n\nRECOMMENDATION: A six-month followup right breast ultrasound is recommended\nto assess stability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nThere is a circumscribed oval mass in the right upper outer quadrant. Without\nassociated calcifications or distortion. This on same day ultrasound\ncorresponds to a 5 mm circumscribed hypoechoic mass in the 10 o'clock which\ncould represent a complicated cyst.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper outer quadrant was scanned. In the 10 o'clock 5 cm from the nipple\nthere is an oval circumscribed hypoechoic mass which measures 0.5 by 0.2 x 0.5\ncm and demonstrates no internal vascularity and good through transmission.\nThis corresponds to the mammographic finding and could represent a complicated\ncyst and less likely a solid mass.", + "output": "Benign-appearing 5 mm mass in the right breast 10 o'clock which could\nrepresent either a complicated cyst or a solid mass.\n\nRECOMMENDATION: A six-month followup right breast ultrasound is recommended\nto assess stability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "There is a stable 0.5 x 0.5 x 0.3 cm cystic appearing lesion likely\nrepresenting a small cyst. Continued followup imaging in six months seems\nreasonable at this time. At the next visit, the patient will also be due for\nbilateral mammography.", + "output": "Stable probable benign cystic lesion in the right breast at 10 o'clock for\nwhich continued followup imaging in six months seems reasonable at this time.\n\nRECOMMENDATION: Bilateral diagnostic mammography and right breast ultrasound\nin six months\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is a low-density 5 mm mass in the upper slightly outer right breast at\nmid to posterior depth. A percutaneous biopsy clip in the upper central right\nbreast corresponds to prior benign biopsy. There is no unexplained\narchitectural distortion or suspicious grouped microcalcifications in either\nbreast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of\npreviously documented finding on ultrasound. At 10 o'clock 3-5 cm from the\nnipple, there is a stable 0.5 x 0.5 x 0.3 cm circumscribed hypoechoic mass\nwithout dominant vascularity or posterior features.", + "output": "___ year stability of probably benign lesion at 10 o'clock in the right breast,\nwhich is most likely a complicated cyst.\n\nRECOMMENDATION(S): Continued followup with right breast ultrasound in ___ year\nseems reasonable, at which time the patient will be due for annual screening\nmammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the right breast at 10 o'clock 5 cm from the nipple\ndemonstrates a cyst which is decreased in size compared to prior exam, now\nmeasuring 2 mm x 2 mm by 4 mm. Due to the decrease in size, no further\nfollow-up is needed.", + "output": "Decrease in size of previously described cyst in the right breast.\nNo sonographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "This exam was originally scheduled to be a percutaneous cholecystostomy tube\ninsertion. During the initial ultrasound assessment of the patient, the\npatient's treating team informed us that the patient's white blood cell count\nand overall clinical status was improving, and that they would prefer to hold\noff on the cholecystostomy tube insertion at the current time. The procedure\nwas therefore aborted.", + "output": "Percutaneous cholecystostomy tube insertion canceled by the treating team\nshortly after beginning planning ultrasound portion of the procedure. No\ncholecystostomy tube insertion was performed." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 54, 64, and 86 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 64 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has severe atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 354, 352, and 272 cm/sec, respectively compatible with\n80-99% stenosis of the internal carotid artery. The peak end diastolic\nvelocity in the left internal carotid artery is 123 cm/sec.\nThe ICA/CCA ratio is 5.8.\nThe external carotid artery has peak systolic velocity of 94 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Significant hemodynamic stenosis of the left internal carotid artery\ncharacterized by severe 80-99% stenosis at the proximal, mid and distal left\ninternal carotid artery as described.\nNo hemodynamic stenosis of the right internal carotid artery.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:46 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." + }, + { + "input": "The aorta measures 2.9 cm in the proximal portion, 2.1 cm in mid portion and\n1.5 cm in the distal abdominal aorta. There is no substantial atherosclerotic\nplaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 0.9 cm and the left common iliac artery\nmeasures 1.0 cm.\n\nIncidental note is made of a diffusely echogenic liver, consistent with\nsteatosis. The right kidney measures 10.3 cm cm and the left kidney measures\n11.2 cm cm. Limited views of the kidneys are unremarkable without\nhydronephrosis. There are multiple exophytic cortical simple renal cysts\nbilaterally.", + "output": "1. No abdominal aortic aneurysm.\n2. Incidental note is made of a diffusely echogenic liver, consistent with\nsteatosis. Other forms of liver disease and more advanced liver disease\nincluding steatohepatitis or significant hepatic fibrosis/cirrhosis cannot be\nexcluded on this study." + }, + { + "input": "RIGHT:\nThere is mild homogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 72.1 cm/s / 13.7 cm/s\nCCA Distal: 64.2 cm/s / 18 cm/s\nICA ___: 54.5 cm/s / 12.2 cm/s\nICA Mid: 55.6 cm/s / 22 cm/s\nICA Distal: 68.2 cm/s / 25.7 cm/s\nECA: 65.9 cm/s\nVertebral: 55.9 cm/s\n\nICA/CCA Ratio: 1.06\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 58 cm/s / 15.2 cm/s\nCCA Distal: 39.5 cm/s / 15.1 cm/s\nICA ___ STENT: 70.3 cm/s / 21.1 cm/s\nICA mid STENT: 69.8 cm/s / 24.1 cm/s\nICA distal STENT: 90.5 cm/s / 28 cm/s\nECA: 347 cm/s\nVertebral: 63.8 cm/s\n\nICA/CCA Ratio: 2.29\n\nPatent left distal CCA and ICA stent.\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis. Patent left distal CCA and ICA stent." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.4 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential,\nculture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential,\nculture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2 L of fluid were removed." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right lobe of the\nliver. A suitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, a single 18-gauge core biopsy sample was\nobtained. The sample was provided to the on-site cytologist who indicated an\nadequate sample.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 25\nmg Versed and 0.5 mcg fentanyl throughout the total intra-service time of 8\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 1, with specimen provided to\nthe cytologist." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast with attention to\narea of clinical concern as indicated by the patient was performed from ___\no'clock 17-30 cm from the nipple which was without any discrete suspicious\nsolid or cystic masses.", + "output": "1. No mammographic evidence of malignancy in either breast.\n2. No suspicious sonographic abnormality is identified in area of clinical\nconcern as indicated by the patient.\n\nRECOMMENDATION(S):\n1. Clinical follow-up as needed for area of discomfort.\n2. Return to age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast with attention to\narea of clinical concern as indicated by the patient was performed from ___\no'clock 17-30 cm from the nipple which was without any discrete suspicious\nsolid or cystic masses.", + "output": "1. No mammographic evidence of malignancy in either breast.\n2. No suspicious sonographic abnormality is identified in area of clinical\nconcern as indicated by the patient.\n\nRECOMMENDATION(S):\n1. Clinical follow-up as needed for area of discomfort.\n2. Return to age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Ultrasound the right common femoral artery: There is a single noncompressible,\narterial, pulsatile lumen. There is evidence of access of the wire into the\nlumen. Images were saved to the patient's permanent medical record.\n\nRight internal carotid artery: Vessel caliber smooth and regular. There is\nopacification of the anterior and middle cerebral arteries and their distal\nterritories. There is a 3 x 3 mm aneurysm with a daughter sac the right\nophthalmic artery. It is unchanged in size compared to the angiogram 1 month\nprior. There is no evidence of additional aneurysm or AVM. The venous phase\nis unremarkable. There is cross-filling across the anterior communicating\nartery of the contralateral A2 segment.\n\nRight internal carotid artery after chemical treatment of vasospasm:\nImprovement of narrowing the internal carotid artery at the tip of the guide\ncatheter.\n\nRight internal carotid artery after pipeline deployment: Vessel caliber smooth\nand regular. There is opacification of the anterior and middle cerebral\narteries. There is evidence of more competitive flow across the anterior\ncommunicating artery from the contralateral side than previously noted. There\nis a pipeline deployed across the neck of the aneurysm. There is good vessel\nwall apposition. There is no evidence of InStent stenosis or vessel dropout\nor thromboembolic complications.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "Uncomplicated pipeline embolization of right ophthalmic artery aneurysm.\n\nLeft ICA aneurysm was ___ 1 at the follow-up angiogram 1 month ago\n\nRECOMMENDATION(S): Follow-up per protocol" + }, + { + "input": "Ultrasound of the right radial artery demonstrates a pulsatile single-lumen\nnon-compressible vessel. There is evidence of needle access into the arterial\nlumen.\n\nRight radial artery: There is good distal runoff. There is no evidence of\ndissection. Vascular caliber is appropriate for catheterization. No\nsignificant stenosis or tortuosity.\n\nRight internal carotid artery the branches are smooth and tapering. Coils in\nthe anterior communicating artery aneurysm can be visualized. There is\nresidual filling in the neck of the aneurysm.\n\nRight external carotid artery branches are smooth and tapering. No early\nvenous drainage or fistulas.", + "output": "1. Residual filling in neck of anterior communicating artery aneurysm after\nprevious coiling consistent with referring ___ grade 2.\n\nI,Dr. ___ , was personally present and participated in the entirety of \nthe procedure; I have reviewed the above images and agree with the findings as\nstated above.\n\nRECOMMENDATION(S):\n1. Treatment options for the residual aneurysm will be discuss during this\ncerebrovascular conference." + }, + { + "input": "Ultrasound of the right radial artery demonstrates a pulsatile single-lumen\nnon-compressible vessel. There is evidence of needle access into the arterial\nlumen.\n\nRight radial artery: There is good distal runoff. There is no evidence of\ndissection. Vascular caliber is appropriate for catheterization. No\nsignificant stenosis or tortuosity.\n\nRight internal carotid artery: The right internal carotid artery is smooth and\nregular. There is filling of the ophthalmic artery with a retinal blush\nvisualized. The posterior communicating artery is patent. There is filling\nof the right M1 segment and the middle cerebral artery and its distal\nterritories. There is filling of the right A1 segment and the bilateral\nanterior cerebral arteries and its distal territories. There is no evidence\nof residual of the previously coiled and clipped anterior communicating artery\naneurysm. Normal capillary and venous phases.", + "output": "1. Complete obliteration of previously coiled and clipped anterior\ncommunicating artery aneurysm.\n\nI,Dr. ___ , was personally present and participated in the entirety of the\nprocedure; I have reviewed the above images and agree with the findings as\nstated above." + }, + { + "input": "At the 5 o'clock to the 6 o'clock position of the right breast 10 cm from the\nnipple, there is no suspicious solid or cystic mass.", + "output": "No sonographic abnormality in the right breast area of clinical concern. Any\ndecision for further intervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The liver shows no evidence of focal lesions or textural abnormality. There is\nno evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is normal without evidence of stones or gallbladder wall\nthickening. The pancreas is unremarkable, without evidence of focal lesions or\npancreatic duct dilatation. Evaluation of the pancreatic tail is limited by\noverlying bowel gas. The spleen is enlarged measuring 14.7 cm and has\nhomogenous echotexture. There is mild fullness of the left renal pelvis.\nRight and left kidneys are otherwise normal without masses, hydronephrosis or\nstones. The right kidney measures 11.1 cm and left kidney measures 11.2 cm.\nThe aorta is of normal caliber throughout, without evidence of atherosclerotic\nplaques. The visualized portions of the inferior vena cava appear normal.\n\nDOPPLER COLOR FLOW AND SPECTRAL WAVEFORM ANALYSIS: The main, left and right\nportal veins, including both anterior and posterior segments, are patent with\nappropriate directionality of flow. The main hepatic artery presents a normal\nwaveform. The right, middle and left hepatic veins are patent with appropriate\ndirectionality of flow. The IVC is within normal limits. The SMV and splenic\nvein are patent with appropriate directionality of flow.", + "output": "1. Splenomegaly. Otherwise, normal abdominal ultrasound.\n\n2. Patent hepatic veins, portal veins and hepatic artery with appropriate\ndirectionality of flow and waveforms." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications bilaterally. No suspicious abnormalities are seen in the\nvicinity of the radiopaque marker placed in the area of focal pain in the\nupper inner right breast.\n\nBREAST ULTRASOUND: Targeted breast ultrasound of the upper inner right breast\nin the area of focal tenderness demonstrate normal morphology with no\nsonographic signs of mass, cyst, or any concerning lesions.", + "output": "No suspicious mammographic or sonographic findings in the area of focal\ntenderness in the upper inner right breast.\n\nRECOMMENDATION(S): Clinical follow-up for the area concern in the right\nbreast is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nRight breast: There is an oval circumscribed equal density 11 mm mass in the\ninner slightly lower right breast at posterior depth.\n\nLeft breast: There is an approximately 11 mm focal asymmetry in the\nupper-outer posterior left breast. There are no associated calcifications or\narchitectural distortion. There is no definite mass.\nBilateral dermal calcifications consistent with prior reduction mammoplasty\nare seen. There is a dystrophic calcification in the upper central left\nbreast.\n\nBREAST ULTRASOUND:\n\nRight breast: Targeted ultrasound of the lower inner right breast was\nperformed. In the 4 o'clock position 5 cm from nipple there is an oval\nparallel well-circumscribed hypoechoic mass measuring 10 x 4 x 7 mm. There is\nno internal vascularity. This mass corresponds to the mammographic mass of\nconcern on the recent screening mammogram. No other suspicious cystic or\nsolid masses are seen.\n\nLeft breast: Targeted ultrasound of the upper-outer left breast was performed.\nIn the the 3 o'clock position approximately 16 cm from the nipple there is a\n10 x 4 x 11 mm heterogeneous area, which is felt to represent a patch of\nnormal breast tissue and a likely correlate to the focal asymmetry in the\nupper-outer left breast. Incidentally, normal appearing lower axillary lymph\nnodes are seen further laterally in the 3 o'clock position left breast.", + "output": "There is a probably benign 11 mm mass in the 4 o'clock position 5 cm from\nnipple in the right breast, likely representing a complicated cyst. Focal\nasymmetry in the upper-outer left breast is likely benign, probably presenting\na patch of normal glandular tissue.\n\nRECOMMENDATION(S): Followup bilateral diagnostic mammogram and ultrasound is\nrecommended in 6 months to document stability of the above findings.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nRight breast: There is an oval circumscribed equal density 11 mm mass in the\ninner slightly lower right breast at posterior depth.\n\nLeft breast: There is an approximately 11 mm focal asymmetry in the\nupper-outer posterior left breast. There are no associated calcifications or\narchitectural distortion. There is no definite mass.\nBilateral dermal calcifications consistent with prior reduction mammoplasty\nare seen. There is a dystrophic calcification in the upper central left\nbreast.\n\nBREAST ULTRASOUND:\n\nRight breast: Targeted ultrasound of the lower inner right breast was\nperformed. In the 4 o'clock position 5 cm from nipple there is an oval\nparallel well-circumscribed hypoechoic mass measuring 10 x 4 x 7 mm. There is\nno internal vascularity. This mass corresponds to the mammographic mass of\nconcern on the recent screening mammogram. No other suspicious cystic or\nsolid masses are seen.\n\nLeft breast: Targeted ultrasound of the upper-outer left breast was performed.\nIn the the 3 o'clock position approximately 16 cm from the nipple there is a\n10 x 4 x 11 mm heterogeneous area, which is felt to represent a patch of\nnormal breast tissue and a likely correlate to the focal asymmetry in the\nupper-outer left breast. Incidentally, normal appearing lower axillary lymph\nnodes are seen further laterally in the 3 o'clock position left breast.", + "output": "There is a probably benign 11 mm mass in the 4 o'clock position 5 cm from\nnipple in the right breast, likely representing a complicated cyst. Focal\nasymmetry in the upper-outer left breast is likely benign, probably presenting\na patch of normal glandular tissue.\n\nRECOMMENDATION(S): Followup bilateral diagnostic mammogram and ultrasound is\nrecommended in 6 months to document stability of the above findings.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\n\nThere is a stable oval mass in the lower inner right breast. There is a\nstable focal asymmetry in the left lateral, slightly superior breast.\n\nBREAST ULTRASOUND: Sonographic evaluation of the right breast demonstrates\nstable appearance of a 0.9 x 0.5 x 0.6 cm ovoid, well-circumscribed, parallel\nhypoechoic mass at 4 o'clock, 5 cm from the nipple. No internal vascularity\ndemonstrated. No sonographic correlate was identified in the left breast to\ncorrespond to the focal asymmetry on mammography. The previously described\nlymph node in the left breast at 3 o'clock was not identified today.", + "output": "Stable right breast mass. Stable left breast focal asymmetry without\nsonographic correlate.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and right breast ultrasound\nin 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "MAMMOGRAM:\nTissue density: B - There are scattered areas of fibroglandular density.\n\nThere is a stable 1 cm circumscribed, oval mass in the right lower inner\nbreast. There is a focal asymmetry in the left upper outer anterior breast\nthat does not completely resolve on spot compression images. There are stable\npost-operative changes from bilateral reduction mammoplasty.\n\nBREAST ULTRASOUND:\nThere is a stable 0.9 x 0.6 x 0.4-cm, hypoechoic, circumscribed,\nparallel-oriented mass without internal vascularity in the right breast at\n4:00, 5 cm from the nipple corresponding to the right lower inner breast mass\non the mammogram.\n\nTargeted ultrasound of the left breast at ___, 16 cm from the nipple\ndemonstrates no sonographic correlate for the mammographic asymmetry. No\nsuspicious mass or sonographic finding is identified.", + "output": "1. Stable oval right lower inner breast mass for ___ year.\n2. Stable left upper outer breast focal asymmetry for ___ year without a\nsonographic correlate.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and bilateral breast\nultrasound in ___ year to confirm ___ year stability of the right breast mass and\nleft breast asymmetry.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the area of palpable concern indicated by the patient\nin the outer left breast was performed. There are no suspicious cystic or\nsolid masses seen.", + "output": "There are no suspicious sonographic findings in the area of palpable concern\nin the outer left breast.\n\nRECOMMENDATION(S): Clinical follow-up is recommended. Final patient\ndisposition should based on clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 71.4 cm/s / 10.6 cm/s\nCCA Distal: 75.2 cm/s / 15 cm/s\nICA ___: 70.8 cm/s / 5.59 cm/s\nICA Mid: 56.5 cm/s / 14.7 cm/s\nICA Distal: 63.7 cm/s / 12.7 cm/s\nECA: 128 cm/s\nVertebral: 38.8 cm/s\n\nICA/CCA Ratio: 0.94\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 114 cm/s / 13.9 cm/s\nCCA Distal: 87.6 cm/s / 18.2 cm/s\nICA ___: 70.4 cm/s / 7.77 cm/s\nICA Mid: 72.4 cm/s / 13.2 cm/s\nICA Distal: 61.9 cm/s / 16.2 cm/s\nECA: 181 cm/s\nVertebral: 39.4 cm/s\n\n\nICA/CCA Ratio: 0.83\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.3 L of serosanguinous fluid were removed. Fluid samples\nwere submitted to the laboratory for cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: right lower quadrant\nFluid: 200 cc of clear, yellow fluid\nSamples: Fluid samples were submitted to the laboratory the requested\nanalysis.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 200 cc of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Right upper quadrant\nFluid: 2.3 L of clear yellow fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.3 L of fluid were removed." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed which was without any\ndiscrete suspicious solid or cystic masses.", + "output": "There is no evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening mammography is recommended. Further\nmanagement of the patient's breast pain should be based clinical assessment.\n\nNOTIFICATION: Findings and recommendations reviewed with the patient at the\ncompletion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 7.75 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7.75 L of fluid were removed.\n3. The patient was discharged in a hemodynamically stable condition." + }, + { + "input": "Limited preprocedural grayscale and Doppler ultrasound imaging of the abdomen\ndemonstrated thickening and heterogeneity of the omentum. The omental fat for\nbiopsywas identified in anterior right lower quadrant of the abdomen.", + "output": "Uncomplicated fine needle and core biopsy of the right lower quadrant omentum.\nThe specimens were provided to the on-site cytologist who indicated adequacy\nof the samples." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.4 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential,\nculture, and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 2.4 L of fluid were removed." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is been apparent interval diffuse increase in density of fibroglandular\ntissue. This possibly is due to the technique as patient did not tolerate\ncompression secondary to pain. However, additional causes including an\ninvasive lobular cancer cannot be excluded. There is no discrete mass,\nunexplained architectural distortion or suspicious grouped calcifications.\n\nBILATERAL BREAST ULTRASOUND: Ultrasound examination of both breasts were\nperformed and no solid or cystic mass was identified.", + "output": "Apparent interval diffuse increase in density fibroglandular tissue in the\nright breast, likely secondary to differences in technique.\n\nRECOMMENDATION(S): Recommend 3 month followup right diagnostic mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. No masses confirmed in the inner right breast in the\narea of concern recent screening mammogram.\n\nBREAST ULTRASOUND: Careful ultrasound of the entire inner right breast was\nperformed. Incidentally, at 1 to 2:00 position 4 cm from the nipple there is\na 6 mm simple cyst. A smaller adjacent simple cyst is noted. There are no\nsuspicious cystic or solid masses throughout the inner right breast.", + "output": "There is a simple cyst, however no suspicious mammographic or sonographic\nfindings in the area of concern on recent screening mammogram in the inner\nright breast.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. No masses confirmed in the inner right breast in the\narea of concern recent screening mammogram.\n\nBREAST ULTRASOUND: Careful ultrasound of the entire inner right breast was\nperformed. Incidentally, at 1 to 2:00 position 4 cm from the nipple there is\na 6 mm simple cyst. A smaller adjacent simple cyst is noted. There are no\nsuspicious cystic or solid masses throughout the inner right breast.", + "output": "There is a simple cyst, however no suspicious mammographic or sonographic\nfindings in the area of concern on recent screening mammogram in the inner\nright breast.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe area questioned on the recent screening study does not persist with\ncertainty on the additional imaging today. Given breast tissue density,\ntargeted ultrasound was performed as a complementary exam. Mammographically,\nno suspicious dominant mass, suspicious grouped microcalcifications, or\nunexplained architectural distortion is seen.\n\nTargeted ultrasound of the left retroareolar and medial breast was performed\nwith attention to the area of questioned mammographic abnormality. A 4 mm\ncyst is seen in the left breast at 10 o'clock, 2 cm from the nipple. This is\nfelt to be incidental. No solid or suspicious mass is noted.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Resume annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe area questioned on the recent screening study does not persist with\ncertainty on the additional imaging today. Given breast tissue density,\ntargeted ultrasound was performed as a complementary exam. Mammographically,\nno suspicious dominant mass, suspicious grouped microcalcifications, or\nunexplained architectural distortion is seen.\n\nTargeted ultrasound of the left retroareolar and medial breast was performed\nwith attention to the area of questioned mammographic abnormality. A 4 mm\ncyst is seen in the left breast at 10 o'clock, 2 cm from the nipple. This is\nfelt to be incidental. No solid or suspicious mass is noted.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Resume annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Pre procedure imaging demonstrates a 1.8 x 1.5 x 1.4 cm irregular hypoechoic\nmass with an internal clip at 2 o'clock 12 cm from the nipple, consistent with\nthe biopsied cancer, which was the target for wire localization.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained. The patient's\nallergies and medications were reviewed. A pre-procedure time-out was\nperformed using three patient identifiers, with confirmation of side and site.\n\nThe patient's left breast was scanned and the mass was identified. Using\nstandard aseptic technique, and ___ cc of 1% lidocaine for local anesthesia, a\nlocalizing needle and subsequently a wire were placed through the lesion under\nultrasound guidance from the lateral approach. The target is located at the\nmid stiffener.\n\n\nThe patient tolerated the procedure well. There were no immediate\ncomplications. She was sent to nuclear medicine, with printed, annotated\nimages.\nThe procedure was supervised by Dr. ___ (Attending).", + "output": "Technically successful ultrasound wire localization of mass in the left\nbreast." + }, + { + "input": "The right lobe measures: 1.7 x 0.9 x 3.4 cm (transverse, AP and craniocaudal).\nThe left lobe measures: 1.2 x 0.7 x 3.0 cm (transverse, AP and craniocaudal).\nIsthmus anterior-posterior diameter is 0.5 cm.\n\nIn the right aspect of isthmus there is a 1.4 x 1.3 x 0.9 cm heterogeneously\nhypoechoic nodule with minimal peripheral flow. No other thyroid nodule is\nidentified. The right and left thyroid lobes are unremarkable, without\ndiscrete nodule or abnormal vascularity. In level 3 of the left neck there is\na 2.1 x 1.2 x 0.6 cm hypoechoic, ovoid-shaped lymph node with minimal internal\nflow.", + "output": "Heterogeneously hypoechoic nodule in the right aspect of the isthmus with\nassociated prominent lymph node without discernible fatty hilum. FNA is\nrecommended." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe focal asymmetry in the central breast does not persist on any of the views\nperformed today and is most compatible with superimposed fibroglandular\ntissue. Ultrasound was performed for confirmation given the breast density. \nThere is no suspicious mass, suspicious grouped microcalcifications or\narchitectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the retroareolar\nregion. No suspicious solid or cystic mass was identified.", + "output": "Left breast focal asymmetry is compatible with superimposed fibroglandular\ntissue. No specific mammographic evidence of malignancy in the left breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The right lobe measures: 1.3 x 1.7 x 3.5 cm (transverse, AP and craniocaudal).\nThe left lobe measures: 1.0 x 0.9 x 2.9 cm (transverse, AP and craniocaudal).\nIsthmus anterior-posterior diameter is 0.2 cm.\n\nMultiple nodules are as are seen in the right thyroid lobe. The dominant\nnodule is located in the lower pole, is homogeneously hyperechoic and measures\n1.3 x 0.7 x 1.2 cm, with minimal internal flow. Another homogeneously\nhyperechoic nodule in the lower pole of the right thyroid lobe measures 0.4 x\n0.6 x 0.4 cm and an isoechoic nodule in the anterior aspect of the midpole of\nthe right thyroid lobe measures 0.6 x 0.4 x 0.6 cm. No calcifications are\nidentified.\n\nThe left thyroid lobe is slightly heterogeneous without discrete nodule. No\ncervical lymphadenopathy was identified.", + "output": "Multiple nodules in the right thyroid lobe, with a dominant nodule measuring\n1.3 x 0.7 x 1.2 cm. No microcalcifications or significant vascularity is\nidentified related to these nodules. Followup in 6 months is recommended." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n52/19 cm/sec in its proximal portion, 98/36 cm/sec in its mid portion, and\n97/32 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n76/24 cm/sec.\nThe external carotid artery has peak systolic velocity of 91 cm/sec.\nThe vertebral artery has peak systolic velocity of 44 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.2.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n72/34 cm/sec in its proximal portion, 92/35 cm/sec in its mid portion, and\n78/31 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 94/32\ncm/sec.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery has peak systolic velocity of 37 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.97.", + "output": "No ICA stenosis." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: The breast tissue is heterogeneously dense which may obscure\nthe detection for small masses.\nNo abnormality is seen in the right breast at the site of palpable concern.\nThere is no dominant mass, unexplained architectural distortion or suspicious\ngrouped microcalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nUltrasound was targeted to the 11 and 12 o'clock 2 cm from the nipple along\nthe age of the area lower at the site of clinical concern. In the 12 o'clock 2\ncm, there is focal thickening of the skin up to 4 mm with hypoechoic area is\nseen in the dermis. This corresponds to the patient's palpable concern and\ndemonstrates no posterior features or internal vascularity. The underlying\nbreast parenchyma is normal.", + "output": "Area of clinical concern corresponds to a dermal lesion which could represent\na resolving inflamed ___ gland. No evidence of malignancy.\n\nRECOMMENDATION: Final disposition of any clinical symptoms should be based on\nclinical grounds. Age-appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "At the site of the previously seen pseudoaneurysm in the right groin there is\na residual 0.8 x 0.5 cm hypoechoic lesion without internal flow. This lesion\npreviously measured 1.4 x 0.9 cm and showed internal flow and communication\nthrough a narrow neck with the CFA which no longr shows flow. The right common\nfemoral artery and vein are patent.", + "output": "Interval resolution of pseudoaneurysm in the right groin." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 49 cm/s / 11 cm/s\nCCA Distal: 37 cm/s / 8 cm/s\nICA ___: 33 cm/s / 9 cm/s\nICA Mid: 39 cm/s / 10 cm/s\nICA Distal: 41 cm/s / 7 cm/s\nECA: 58 cm/s\nVertebral: 37 cm/s\n\nICA/CCA Ratio: 1.1 Cm/s\n\nThe right CCA spectral waveform is normal.\nThe right ICA spectral waveform is normal\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is no atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 56 cm/s / 15 cm/s\nCCA Distal: 46 cm/s / 11 cm/s\nICA ___: 42 cm/s / 11 cm/s\nICA Mid: 46 cm/s / 11 cm/s\nICA Distal: 42 cm/s / 11 cm/s\nECA: 68 cm/s\nVertebral: 23 cm/s\n\nICA/CCA Ratio: 1.0 cm/s\n\nThe left CCA spectral waveform is normal.\nThe left ICA spectral waveform is normal.\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "0% stenosis in the bilateral carotid arteries" + }, + { + "input": "RIGHT:\nThere is severe heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 98.2 cm/s / 18 cm/s\nCCA Distal: 90.1 cm/s / 16 cm/s\nICA ___: 230 cm/s / 45.8 cm/s\nICA Mid: 211 cm/s / 36 cm/s\nICA Distal: 78.4 cm/s / 20.4 cm/s\nECA: 145 cm/s\nVertebral: 49.1 cm/s\n\nICA/CCA Ratio: 2.55\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 82.3 cm/s / 18.4 cm/s\nCCA Distal: 64.9 cm/s / 21.3 cm/s\nICA ___: 191 cm/s / 31.6 cm/s\nICA Mid: 154 cm/s / 32.9 cm/s\nICA Distal: 112 cm/s / 28.2 cm/s\nECA: 214 cm/s\nVertebral: 48.5 cm/s\n\nICA/CCA Ratio: 2.94\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 70-79% stenosis.\nLeft ICA 60-69% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 49, 60, and 66 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 47 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 61 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 83, 84, and 80 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 61 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral extracranial internal carotid\narteries." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nPreprocedure grayscale and Doppler ultrasound imaging was also used to\nidentify the largest pocket of ascites in the right upper quadrant. A\nsuitable target for paracentesis was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nparacentesis was chosen. The site was marked. The skin was then prepped and\ndraped in the usual sterile fashion. A ___ needle was uneventfully inserted\nand connected to a vacutainer and ascites fluid was left to drain.\n\nSubsequently, an appropriate skin entry site for the biopsy was chosen. The\nsite was marked. The skin was then prepped and draped in the usual sterile\nfashion. The superficial soft tissues to the liver capsule were anesthetized\nwith 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 4 18-gauge core biopsy passes were made. \nThe sample was placed in formalin.\n\n The biopsy tract was embolized with absorbable gelatin sponge pledgets to\nreduce the risk of biopsy-site bleeding.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 75 mcg fentanyl throughout the total intra-service time of 60\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "1. Uncomplicated 18-gauge targeted liver biopsy x 4, with specimen sent to\npathology.\n2. Uncomplicated small volume paracentesis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 44 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 27, 47, and 57 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 16\ncm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 46 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 47 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 28, 35, and 38 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 12\ncm/sec.\nThe ICA/CCA ratio is 0.80.\nThe external carotid artery has peak systolic velocity of 45 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA no stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Within the left axilla multiple benign appearing lymph nodes are identified\ndemonstrating normal homogeneous cortical thickness. The largest lymph node\nmeasures 1.6 cm x 1.3 cm x 0.4 cm. No suspicious solid lesions are\nidentified.", + "output": "Prominent left axillary lymph nodes without suspicious features.\n\nRECOMMENDATION(S): Continued clinical followup is recommended.\n\nNOTIFICATION: Patient was told to follow-up with his clinician.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere are stable postsurgical changes from reduction mammoplasty. There are\ndystrophic calcifications in the right breast underlying the skin marker\nconsistent with fat necrosis, as seen on prior studies, including the largest\nmeasuring 17 mm. There is no suspicious mass, architectural distortion or\ngrouped microcalcification.", + "output": "No specific mammographic evidence of malignancy. Focal right breast pain\ncorresponds to stable right breast fat necrosis, which is benign. Any\ndecision for further intervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up. Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 42 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 46, 61, and 49 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 17\ncm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 68 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 50 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 51, 57, and 54 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 20\ncm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 62 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild, heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 73, 85, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 101 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild, heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 95 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 76, 88, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 0.93.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Less than 40% carotid stenosis bilaterally.\n\n2. Mild, heterogeneous atherosclerotic plaque bilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 89 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 80, 89, and 83 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 37 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 75, 87, and 84 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of stenosis in the right or left internal carotid artery." + }, + { + "input": "Again seen are multiple subcutaneous nodules both on clinical exam as well as\nunder ultrasound. Right, infraclavicular nodule, not visible on the patient's\nskin was selected for subcutaneous biopsy.", + "output": "Technically successful, ultrasound-guided biopsy of right infraclavicular\nnodule. Specimens were sent for pathology and microbiology evaluation." + }, + { + "input": "DIGITAL DIAGNOSTIC BILATERAL MAMMOGRAM WITH CAD:\nTissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nA partially circumscribed partially obscured mass is noted in the central\nouter left breast measuring up to approximately 1.9 cm. No additional\nabnormalities are noted.\n\nBILATERAL BREAST ULTRASOUND: At 3 o'clock 3cm from the nipple there is a 1.9\nx 0.8 x 1.4 cm simple cyst that correlates with the mass on mammography. \nInnumerable additional simple cysts and grouped microcysts are noted.No\nabnormality is noted in either retroareolar breast or in the upper outer left\nbreast.", + "output": "No abnormality to correlate with the bilateral nipple discharge or the left\nupper outer pain/fullness. Further management should be based on the clinical\nassessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere fluctuating masses in both breasts, in keeping with benign findings and\nmost likely cysts. There is no suspicious architectural distortion or grouped\nmicrocalcification.\n\nBREAST ULTRASOUND: At the 4 o'clock position of the left breast 4 cm from the\nnipple, corresponding to the area of clinical concern, there is a 2.5 x 1.4 x\n1.1 cm bilobed simple cyst.", + "output": "Left breast simple cyst is benign. Any decision for further intervention\nshould be guided by the clinical assessment. No mammographic evidence of\nmalignancy. .\n\nRECOMMENDATION(S): Clinical follow-up. Age and risk appropriate mammographic\nscreening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient via\ninterpreter who agrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nOn the left, there is a focal asymmetry in the upper-outer quadrant of the\nbreast, anterior depth which is stable.\nAlso, in the medial breast, there is a focal asymmetry, upper-inner quadrant,\nanterior depth that is more prominent than on the last examination. This\nmeasures approximately 1.5 cm in length and is in the region of the palpable\nfinding.\nThe left nipple is retracted with no retroareolar abnormality seen. Review of\nthe previous examination shows a similar appearance to the nipple, despite the\nclinical report of a new finding.\nOn the right, there is no change with no developing mass, area of\narchitectural distortion or suspicious calcifications. The right nipple is\nflattened, as before.\nBREAST ULTRASOUND: Targeted examination to the retroareolar portion of the\nbreast, upper outer and upper inner quadrant performed. Outside ultrasound\ndated ___ has been reviewed.\nNo retro areolar mass is demonstrated. There are a few prominent ducts but no\nsignificant ductal dilatation is evident.\nAlong the 11 o'clock axis and at a distance of 2-4 cm from the nipple, there\nis a region of heterogeneous echogenicity which has the appearance of\nfibroglandular tissue. There is no mass or shadowing abnormality.\nImages obtained of the upper inner quadrant in ___ show no similar finding.\nHence, this may be related to the recording of only selected images at that\ntime, rather than related to a new finding.\nThere is a small region of fibroglandular tissue along the 2- 3 o'clock axis\nand at a distance of 0-4 cm from the nipple. This likely corresponds to the\nstable focal mammographic asymmetry reported above.", + "output": "1. Focal left breast asymmetry is present on mammography in the area of the\npatient's palpable finding. There is, however, no abnormality on ultrasound. \nThis is likely a more prominent region of fibroglandular tissue.\n2. No change in the appearance of either nipple is seen when compared to the\nlast mammogram. Given the clinical history of new left nipple inversion, MRI\nshould be considered.\n\nRECOMMENDATION: Clinical followup including surgical consultation\nrecommended, given the palpable finding on the left. If there is a significant\nclinical change with a developing mass or nipple changes then MRI should be\nconsidered for further assessment.\n\nNOTIFICATION: Findings reviewed in detail with the patient at the completion\nof the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nOn the left, there is a focal asymmetry in the upper-outer quadrant of the\nbreast, anterior depth which is stable.\nAlso, in the medial breast, there is a focal asymmetry, upper-inner quadrant,\nanterior depth that is more prominent than on the last examination. This\nmeasures approximately 1.5 cm in length and is in the region of the palpable\nfinding.\nThe left nipple is retracted with no retroareolar abnormality seen. Review of\nthe previous examination shows a similar appearance to the nipple, despite the\nclinical report of a new finding.\nOn the right, there is no change with no developing mass, area of\narchitectural distortion or suspicious calcifications. The right nipple is\nflattened, as before.\nBREAST ULTRASOUND: Targeted examination to the retroareolar portion of the\nbreast, upper outer and upper inner quadrant performed. Outside ultrasound\ndated ___ has been reviewed.\nNo retro areolar mass is demonstrated. There are a few prominent ducts but no\nsignificant ductal dilatation is evident.\nAlong the 11 o'clock axis and at a distance of 2-4 cm from the nipple, there\nis a region of heterogeneous echogenicity which has the appearance of\nfibroglandular tissue. There is no mass or shadowing abnormality.\nImages obtained of the upper inner quadrant in ___ show no similar finding.\nHence, this may be related to the recording of only selected images at that\ntime, rather than related to a new finding.\nThere is a small region of fibroglandular tissue along the 2- 3 o'clock axis\nand at a distance of 0-4 cm from the nipple. This likely corresponds to the\nstable focal mammographic asymmetry reported above.", + "output": "1. Focal left breast asymmetry is present on mammography in the area of the\npatient's palpable finding. There is, however, no abnormality on ultrasound. \nThis is likely a more prominent region of fibroglandular tissue.\n2. No change in the appearance of either nipple is seen when compared to the\nlast mammogram. Given the clinical history of new left nipple inversion, MRI\nshould be considered.\n\nRECOMMENDATION: Clinical followup including surgical consultation\nrecommended, given the palpable finding on the left. If there is a significant\nclinical change with a developing mass or nipple changes then MRI should be\nconsidered for further assessment.\n\nNOTIFICATION: Findings reviewed in detail with the patient at the completion\nof the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. Overall, the left breast has more glandular tissue\nthan the right consistent with normal variation. No suspicious mass, area of\narchitectural distortion or cluster of suspicious microcalcification is\nappreciated.\n\nUltrasound of the left breast from ___ o'clock 1-8 cm from the nipple in the\narea of concern as indicated by the patient was performed. No solid\nsuspicious mass or cystic lesion is seen. Any decision to biopsy at this time\nand further management of the patient's symptoms at this time should be based\non the clinical assessment.", + "output": "No focal mammographic or sonographic abnormality identified in the left breast\nin an area of concern as indicated by the patient. Any decision to biopsy at\nthis time and further management of the patient's symptoms at this time should\nbe based on the clinical assessment.\n\nRECOMMENDATION: Clinical followup\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. Overall, the left breast has more glandular tissue\nthan the right consistent with normal variation. No suspicious mass, area of\narchitectural distortion or cluster of suspicious microcalcification is\nappreciated.\n\nUltrasound of the left breast from ___ o'clock 1-8 cm from the nipple in the\narea of concern as indicated by the patient was performed. No solid\nsuspicious mass or cystic lesion is seen. Any decision to biopsy at this time\nand further management of the patient's symptoms at this time should be based\non the clinical assessment.", + "output": "No focal mammographic or sonographic abnormality identified in the left breast\nin an area of concern as indicated by the patient. Any decision to biopsy at\nthis time and further management of the patient's symptoms at this time should\nbe based on the clinical assessment.\n\nRECOMMENDATION: Clinical followup\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.75 L of clear, straw-colored fluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated ultrasound-guided therapeutic paracentesis." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nOverall appearance of both breasts is similar though there is a convexity to\nthe margin of the glandular tissue on spot views in the area of clinical\nconcern in the upper breast. This, however, is not significantly different\nfrom the right. There are a few benign calcifications in the retroareolar\nportion of the left breast. There are no areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted examination on the left demonstrates a large\nregion of heterogeneous appearing fibroglandular tissue in the upper central\nbreast in the area of focal pain. Along the 6 o'clock axis and 4-5 cm from\nthe nipple, several small cysts are seen within a patch of heterogeneous\nappearing tissue. The largest of the cysts measures 0.5 cm. No solid masses\nare seen.\nThe right scanning of the upper-outer quadrant and lower inner quadrant in the\nsymptomatic areas shows heterogeneous appearing fibroglandular tissue with no\nsolid or cystic masses.", + "output": "1. Mammography shows dense breast parenchyma with no specific findings of\nmalignancy.\n2. There is no mammographic mass in the upper central left breast where the\npatient has an area of palpable concern. Hence clinical followup of this area\nis recommended.\n3. Re- demonstration of several subcentimeter cysts in the lower left breast\nin the area of pain.\n4. No ultrasound abnormality on the right in the upper-outer quadrant and\nlower-inner quadrant to correlate with patient's symptomatology.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nOverall appearance of both breasts is similar though there is a convexity to\nthe margin of the glandular tissue on spot views in the area of clinical\nconcern in the upper breast. This, however, is not significantly different\nfrom the right. There are a few benign calcifications in the retroareolar\nportion of the left breast. There are no areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted examination on the left demonstrates a large\nregion of heterogeneous appearing fibroglandular tissue in the upper central\nbreast in the area of focal pain. Along the 6 o'clock axis and 4-5 cm from\nthe nipple, several small cysts are seen within a patch of heterogeneous\nappearing tissue. The largest of the cysts measures 0.5 cm. No solid masses\nare seen.\nThe right scanning of the upper-outer quadrant and lower inner quadrant in the\nsymptomatic areas shows heterogeneous appearing fibroglandular tissue with no\nsolid or cystic masses.", + "output": "1. Mammography shows dense breast parenchyma with no specific findings of\nmalignancy.\n2. There is no mammographic mass in the upper central left breast where the\npatient has an area of palpable concern. Hence clinical followup of this area\nis recommended.\n3. Re- demonstration of several subcentimeter cysts in the lower left breast\nin the area of pain.\n4. No ultrasound abnormality on the right in the upper-outer quadrant and\nlower-inner quadrant to correlate with patient's symptomatology.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: D- The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. Specifically, no suspicious abnormalities are seen in\nthe vicinity of the radiopaque marker placed in the area of palpable concern\nin the inner slightly upper right breast. Scattered punctate calcifications\nin the left breast are unchanged since prior mammogram.\n\nBREAST ULTRASOUND: Targeted ultrasound of the area of palpable concern in the\nupper inner right breast was performed. At 1:00 position 3 cm from the nipple\nthere is an anechoic oval circumscribed mass measuring 8 x 5 x 8 mm. This\nanechoic mass is thought to also correspond to the suspicious mass with \nrestricted diffusion seen on recent MRI.\n\nTargeted ultrasound of the lower left breast, including the area of palpable\nconcern in the lower left breast was performed. Several simple cysts are\nnoted in the area of palpable concern at 6:00 position, however no suspicious\ncystic or solid mass is seen. No correlate is found to the area of linear non\nmass enhancement. Ultrasound of both axillary regions revealed\nnormal-appearing lymph nodes.", + "output": "1. There is an 8 mm anechoic mass in the upper inner right breast\ncorresponding to the area of palpable concern and to the cystic mass on recent\nMRI. Given the posterior medial location of this mass, MRI guided core needle\nbiopsy may be difficult. Therefore, vacuum assisted ultrasound-guided core\nneedle biopsy is recommended with clip placement. Subsequent MRI will help to\ndetermine if the mass with suspicious MRI appearance was biopsied.\n\n2. No sonographic abnormality was seen in the area of suspicious non mass\nenhancement in the lower left breast. MRI guided core needle biopsy is\ntherefore recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast\nwith clip placement is recommended prior to the performance of the MRI guided\ncore needle biopsy of left breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. ___, N.P. was also notified.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Pre-procedure imaging re-identified an anechoic, oval circumscribed mass\nmeasuring 0.8 x 0.4 x 0.8 cm in the right breast at 1 o'clock 3 cm from the\nnipple. This was targeted for ultrasound-guided core needle biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___. ___, DO. The procedure was supervised by ___,\nM.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 11 guage coaxial needle was placed adjacent to the lesion\nand using a 12 guage vacuum assisted Surus biopsy device, 6 cores were\nobtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology\nAnesthesia: 3 cc 1% lidocaine in skin and tissue pre-procedure and 10 cc\nlidocaine infused through out procedure.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "1. Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n2. MRI biopsy of the left breast non mass enhancement, as per recommendations\nfrom the breast MRI dated ___.\n\nRECOMMENDATION:\nMRI biopsy of the previously seen left breast non mass enhancement, as per\nrecommendations from prior breast MR dated ___. At that time,\nconfirmation of clip placement from ultrasound-guided core needle biopsy of\nthe right breast can be made to verify that the previously seen MRI finding in\nthe upper inner right breast correlates with the biopsy clip.\n\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Pre-procedure imaging re-identified an anechoic, oval circumscribed mass\nmeasuring 0.8 x 0.4 x 0.8 cm in the right breast at 1 o'clock 3 cm from the\nnipple. This was targeted for ultrasound-guided core needle biopsy.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___. ___, DO. The procedure was supervised by ___,\nM.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 11 guage coaxial needle was placed adjacent to the lesion\nand using a 12 guage vacuum assisted Surus biopsy device, 6 cores were\nobtained. Next, a percutaneous ribbon clip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology\nAnesthesia: 3 cc 1% lidocaine in skin and tissue pre-procedure and 10 cc\nlidocaine infused through out procedure.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "1. Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n2. MRI biopsy of the left breast non mass enhancement, as per recommendations\nfrom the breast MRI dated ___.\n\nRECOMMENDATION:\nMRI biopsy of the previously seen left breast non mass enhancement, as per\nrecommendations from prior breast MR dated ___. At that time,\nconfirmation of clip placement from ultrasound-guided core needle biopsy of\nthe right breast can be made to verify that the previously seen MRI finding in\nthe upper inner right breast correlates with the biopsy clip.\n\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nAsymmetry noted in the left upper outer breast appears to to correspond to\nasymmetric tissue. Benign-appearing calcifications are seen scattered in both\nbreasts. There are no spiculated masses suspicious grouped\nmicrocalcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. The\nleft breast was scanned over the tender area at ___ o'clock and area of\npalpable abnormality felt by the patient's physician. No discrete solid or\ncystic mass was seen in the area scanned from ___ o'clock.", + "output": "No evidence of malignancy.\nIf prior mammograms become available comparison will be done and an addendum\nwill be dictated.\n\nRECOMMENDATION(S): Final disposition should be based on clinical evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "The bladder is normal in appearance. No clots are identified. Note is made\nof a Foley catheter within the urinary bladder.", + "output": "No sonographic evidence of clot or bladder mass." + }, + { + "input": "Splinted study demonstrates widely patent bilateral internal jugular veins. \nAlthough medial aspects of each subclavian vein are not accessible by\nultrasound, accessible portions are also widely patent. No intraluminal\nthrombus is found.", + "output": "No evidence of venous thrombosis." + }, + { + "input": "In the left breast 05:30 position 2 cm from the nipple, there is an\nill-defined hypoechoic, parallel mass that measures 1.5 x 1.1 x 0.7 cm which\ncorresponds to the enhancing mass seen on the comparison MRI and is targeted\nfor ultrasound-guided core needle biopsy. There are multiple abnormal\nappearing lymph nodes in the left axilla with the largest having cortical\nthickening measuring 0.6 cm which is targeted for FNA. In the right axilla\nthere are at least 2 very deep abnormal appearing lymph nodes with cortical\nthickening measuring up to 0.6 cm. Due to patient anxiety/discomfort and the\ndeep location of these lymph nodes, FNA was not performed on the right\naxillary lymph nodes.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nClinicians: ___, MD ___, M.D.. The procedure was supervised by\n___, M.D.(attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and multiple cores\nwere obtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous HydroMark coil was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nAXILLARY LYMPH NODE FNA: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, fine needle aspiration of the abnormal left axillary lymph\nnode was performed. The needle was removed and hemostasis was achieved.\n\nDue to the deep position of the right axillary lymph nodes and patient\ndiscomfort, further FNA of the right axillary lymph nodes was deferred.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy and fine needle aspiration. \nPathology and FNA are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Left breast:\n\n 05:30 2 cm from the nipple, there is a ill-defined hypoechoic parallel mass\nwithout posterior features and with minimal peripheral vascularity measures\n1.5 x 1.1 x 0.7 cm, this lesion by size and location corresponds to the\nenhancing mass on the comparison MRI. The mass is approximately 2.7 cm medial\nto the seroma, which is noted to have decreased in size significantly on\nreal-time imaging when compared to the MRI.\n\nLeft axilla:\nThere are multiple abnormal lymph nodes in the left axilla demonstrating\ncortical thickening with the largest demonstrated cortical thickening of 0.6\ncm.\n\nRight axilla:\nThere are at least 2 abnormal lymph nodes in the right axilla with cortical\nthickening measuring up to 0.6 cm.", + "output": "1. Left breast mass at 05:30 2 cm from the nipple measures 1.5 cm and\ncorresponds to the enhancing mass on the comparison MRI.\n2. Bilateral enlarged axillary nodes.\n\nRECOMMENDATION(S):\n1. Left breast mass core needle biopsy and clip placement.\n2. Fine-needle aspiration of left axillary lymph node.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "In the left breast 05:30 position 2 cm from the nipple, there is an\nill-defined hypoechoic, parallel mass that measures 1.5 x 1.1 x 0.7 cm which\ncorresponds to the enhancing mass seen on the comparison MRI and is targeted\nfor ultrasound-guided core needle biopsy. There are multiple abnormal\nappearing lymph nodes in the left axilla with the largest having cortical\nthickening measuring 0.6 cm which is targeted for FNA. In the right axilla\nthere are at least 2 very deep abnormal appearing lymph nodes with cortical\nthickening measuring up to 0.6 cm. Due to patient anxiety/discomfort and the\ndeep location of these lymph nodes, FNA was not performed on the right\naxillary lymph nodes.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medications: The patient's medication list and history of\nallergies were reviewed prior to beginning the procedure.\nClinicians: ___, MD ___, M.D.. The procedure was supervised by\n___, M.D.(attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, a\n13-gaugecoaxial needle was placed adjacent to the lesion and multiple cores\nwere obtained using a 14-gauge Bard spring-loaded biopsy device. Next, a\npercutaneous HydroMark coil was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nAXILLARY LYMPH NODE FNA: Using ultrasound guidance, aseptic technique and\nlocal anesthesia, fine needle aspiration of the abnormal left axillary lymph\nnode was performed. The needle was removed and hemostasis was achieved.\n\nDue to the deep position of the right axillary lymph nodes and patient\ndiscomfort, further FNA of the right axillary lymph nodes was deferred.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and cytology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy and fine needle aspiration. \nPathology and FNA are pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "The patient is status post left mastectomy. Limited grayscale ultrasound\nimaging of the left breast demonstrated a collapsed expander, with a small\nvolume of fluid interdigitating between the expander. The largest pocket was\nnot sufficient in size for drain placement.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nbreast at approximately the 9:00 position, and approximately 60 cc of\nstraw-colored fluid was aspirated. There was no significant residual fluid\nremaining to be aspirated.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided aspiration of a left breast seroma,\nwith removal of approximately 60 cc of straw-colored fluid.\n\nThe largest fluid pocket was not sufficient in size for safe drain placement." + }, + { + "input": "Targeted ultrasound of left postoperative breast was performed. There is\nfluid in the postoperative breast seen surrounding the left breast expander. \nThe expander is folded on itself, in particular, in the outer inferior aspect\nof the postoperative breast at ___ o'clock where the expander is seen along\nthe anterior margin of the fluid collection, as well as along the posterior\nmargin.\nIn addition, the expander is folded along the inferior aspect of the\nreconstructed breast at 6 o'clock.\nThere is a small pocket of fluid measuring 3.3 x 1.2 x 4.7 cm along the upper\ninner quadrant at 10 o'clock 5-7 cm from the nipple.", + "output": "Left postoperative seroma with folding of the expander onto itself along the\ninferior and lateral aspects. 4.7 cm fluid collection along the superior\nmedial aspect of the postoperative breast.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with ___ at the completion of\nthe study. Together was decided not to drain the fluid.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 50 mcg fentanyl throughout the total intra-service time of 7\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.6 L of light yellowfluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, personally supervised the procedure,\nsubsequently reviewing and has agreed with the preliminary findings.", + "output": "Uneventful therapeutic paracentesis yielding 2.6 L of light yellow ascitic\nfluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.9 L of clear, straw-coloredfluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis yielding 1.9\nL of clear straw-colored fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3 L of clear yellowfluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Successful therapeutic ultrasound-guided paracentesis with removal of 3 L." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1 L of clear yellow fluid was removed. 20 mL were also sent\nfor additional lab testing.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated diagnostic paracentesis with removal of 1 L for cytology and\nadditional 20 mL for ordered chemistry evaluation." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the transplant kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Local sedation was provided by the nephrology team via 1% lidocaine\nsolution. Please see nephrology note for further details.", + "output": "Ultrasound guidance for percutaneous transplant kidney biopsy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast from\nthe 5 o'clock position to the 9 o'clock position in the area of focal pain,\nwhich was without any discrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy. No sonographic abnormality\nin the right breast area of clinical concern. Any decision for further\nintervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up and annual mammographic screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the right breast from\nthe 5 o'clock position to the 9 o'clock position in the area of focal pain,\nwhich was without any discrete suspicious solid or cystic masses.", + "output": "No specific mammographic evidence of malignancy. No sonographic abnormality\nin the right breast area of clinical concern. Any decision for further\nintervention should be guided by the clinical assessment.\n\nRECOMMENDATION(S): Clinical follow-up and annual mammographic screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Two heterogeneous fluid collections in the right and left pelvis, consistent\nwith tuboovarian abscesses.", + "output": "Successful US-guided placement of two ___ pigtail catheters, one into the\nright and the other into the left tuboovarian abscess. Samples was sent for\nmicrobiology evaluation." + }, + { + "input": "Pelvic collection measuring 12.7 x 10.5 x 8.3 cm.", + "output": "Procedure aborted after multiple attempts due to several technical\ndifficulties as above." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of serosanguinous fluid\nSamples: Fluid samples were submitted to the laboratory for the requested\nanalysis.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated diagnostic and therapeutic paracentesis. 4 L of serosanguineous\nfluid drained. Samples sent for requested analysis.\n\nRECOMMENDATION(S): Albumin administration in the unit." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 2.5 L of serosanguineous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Therapeutic paracentesis. 2.5 L of serosanguineous fluid aspirated. Unable\nto get the target amount of 5 L today." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 1.3 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.3 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 4 L of serosanguinous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed and sent for analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided therapeutic paracentesis\nLocation: Right lower quadrant\nFluid: 4 L of serous fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained via the patient's\ndaughter/healthcare proxy.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n100 mg Versed and 2 mcg fentanyl throughout the total intra-service time of 20\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has significant heterogeneous atherosclerotic\nplaque within the internal carotid artery.\nThe peak systolic velocity in the right common carotid artery is 64 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 163, 128, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 51 cm/sec.\nThe ICA/CCA ratio is 2.5.\nThe external carotid artery has peak systolic velocity of 199 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has significant heterogeneous atherosclerotic\nplaque within the left internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 89 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 190, 178, and 152 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 55 cm/sec.\nThe ICA/CCA ratio is 2.1.\nThe external carotid artery has peak systolic velocity of 228 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Significant heterogeneous atherosclerotic plaque within bilateral internal\ncarotid arteries, right greater than left. However, this results an elevated\npeak systolic velocities within the ICAs, left greater than right. Overall,\nthere is approximately 60-69% stenosis within bilateral ICAs." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in the right hepatic lobe. A\nsuitable approach for targeted liver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 2 18-gauge core biopsy passes were made. \nThe sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 26\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to\npathology." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is an irregular, spiculated, hyperdense mass in the upper outer quadrant\nof the right breast, posterior depth measuring at least 4.7 x 3.5 x 6.1 cm\ncorresponding to the palpable abnormality of concern. There is no definite\nextension to the nipple or skin surface. Extension to the posterior chest\nwall is better evaluated with ultrasound. No suspicious mass,\nmicrocalcifications, or distortion is seen in the left breast.\n\nBREAST ULTRASOUND: Targeted ultrasound of the upper outer quadrant of the\nright breast was performed. At 12 o'clock 3 cm from the nipple in the right\nbreast, there is a 4 x 3.5 x 3.7 cm irregular, hypoechoic mass with angular\nmargins, an echogenic border, and anti parallel orientation corresponding to\nthe palpable and mammographic abnormality of concern. There is no extension\nto the posterior chest wall or skin surface. No suspicious appearing lymph\nnodes are visualized within the right axilla.", + "output": "1. 4 x 3.5 x 3.7 cm irregular right breast mass corresponding to the patient's\npalpable abnormality. This is highly suggestive of malignancy and\nultrasound-guided core needle biopsy is recommended for further evaluation.\n2. No suspicious abnormality within the left breast.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the right breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. The patient is scheduled for ultrasound-guided core needle biopsy of\nthe right breast on ___.\n\nThe impression and recommendation above was entered by Dr. ___ on\n___ at 3pm into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "There is a 3.4 x 3.6 cm irregular, hypoechoic mass with angular margins at the\n12 o'clock position of the right breast approximately 3 cm from nipple\ncorresponding to the patient's palpable abnormality of concern.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___ M.D. ___. ___, N.P.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the mass.", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending.\n\nThe patient expects to hear the pathology results from ___ in ___\nbusiness days. Standard post care instructions were provided to the patient." + }, + { + "input": "There is a 3.4 x 3.6 cm irregular, hypoechoic mass with angular margins at the\n12 o'clock position of the right breast approximately 3 cm from nipple\ncorresponding to the patient's palpable abnormality of concern.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___ M.D. ___. ___, N.P.. The procedure was supervised\nby ___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the mass.", + "output": "Technically successful US-guided core biopsy of the right breast mass. \nPathology is pending.\n\nThe patient expects to hear the pathology results from ___ in ___\nbusiness days. Standard post care instructions were provided to the patient." + }, + { + "input": "Again seen at 12 o'clock 3 cm from the nipple is an irregular hypoechoic mass\nwith angular margins measuring 3.9 x 3.3 x 3.7 cm consistent with the\nbiopsy-proven cancer. This was targeted for ultrasound-guided research\nbiopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, M.D., ___, M.D.. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. The\ncores were placed in a dry Telfa. The needle was removed and hemostasis was\nachieved.\n\nTwo research assistant were present and obtained the specimen after the\nbiopsy.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to research.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful research US-guided core biopsy of the right breast\nlesion. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast at 12 o'clock 3 cm from the nipple is an irregular\nhypoechoic mass measuring 3.6 x 2.9 x 3.7 cm, corresponding to biopsy-proven\nmalignancy\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___, N.P.. The procedure was supervised by ___,\nM.(attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 4 cores were obtained.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Four specimens were placed on a dry Telfa and given to the research\nassistant.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.", + "output": "Technically successful US-guided core biopsy of the known right breast cancer\nfor research purposes. Standard post care instructions were provided to the\npatient." + }, + { + "input": "There is an irregular, hypoechoic mass with angulated margins consistent with\nthe patient's known biopsy proven malignancy measuring 3.3 x 2.9 x 3.1 cm,\npreviously measuring 3.6 x 2.9 x 3.7 cm at the 12 o'clock position of the\nright breast approximately 3 cm from the nipple.", + "output": "Irregular mass consistent with the patient's known biopsy proven malignancy\nnow measuring 3.3 x 2.9 x 3.1 cm, previously measuring 3.6 x 2.9 x 3.7 cm.\n\nRECOMMENDATION(S): Further management per the patient's oncologic team.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "Focused ultrasound evaluation of the right groin demonstrates a persistent 1.5\ncm pseudoaneurysm arising off the common femoral artery. Flow is demonstrated\nwithin the pseudoaneurysm. The common femoral artery, the superficial femoral\nartery and deep femoral artery on the right are patent with appropriate\nwaveforms. The common femoral vein is patent with appropriate waveforms.", + "output": "Persistent 1.5 cm right pseudoaneurysm arising off the right common femoral\nartery." + }, + { + "input": "Limited pre-procedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the pre-procedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nVersed and Fentanyl throughout the total intra-service time of 15 minutes\nduring which patient's hemodynamic parameters were continuously monitored by\nan independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nThere is a central asymmetry in the right breast seen on CC view only which\ndoes not persist on same day and rolled views consistent with overlapping\nfibroglandular tissue. There is no mammographic abnormality to correspond\nwith areas of pain described by the patient in the left breast. Stable\npostoperative changes seen in the central left breast middle third.\n\nNo other abnormality seen in either breast.\n\n\nBREAST ULTRASOUND: There is no sonographic abnormality to correspond with\nareas of tenderness described by the patient in the left breast.", + "output": "No evidence of malignancy\n\nRECOMMENDATION: Annual screening mammogram is recommended\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are stable post treatment changes. There is a dystrophic calcification\nin the left central breast. There are other smaller benign calcifications. \nNo suspicious dominant mass, suspicious grouped calcifications, or unexplained\narchitectural distortion is seen.\n\nTargeted ultrasound of the left breast was performed with attention to the\narea of pain and to the retroareolar region given history of discharge. No\ndilated ducts or intraductal mass is seen. Patient reports pain in the\nlateral breast, most marked at 3 o'clock, 5 cm from the nipple. No discrete\ncystic or solid mass is noted.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Bilateral screening mammogram in ___, ___ year from\nlast bilateral study. Final disposition of any clinical findings should be\nbased on clinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere are stable post treatment changes. There is a dystrophic calcification\nin the left central breast. There are other smaller benign calcifications. \nNo suspicious dominant mass, suspicious grouped calcifications, or unexplained\narchitectural distortion is seen.\n\nTargeted ultrasound of the left breast was performed with attention to the\narea of pain and to the retroareolar region given history of discharge. No\ndilated ducts or intraductal mass is seen. Patient reports pain in the\nlateral breast, most marked at 3 o'clock, 5 cm from the nipple. No discrete\ncystic or solid mass is noted.", + "output": "No specific evidence for malignancy.\n\nRECOMMENDATION(S): Bilateral screening mammogram in ___, ___ year from\nlast bilateral study. Final disposition of any clinical findings should be\nbased on clinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is no appreciable plaque or wall thickening involving either carotid\nsystem except for ___ focal plaque at left proximal ICA. The peak systolic\nvelocities as well as the ICA to CCA ratios are normal bilaterally. There is\nnormal antegrade flow involving both vertebral arteries.", + "output": "Normal duplex and color Doppler assessment of both carotid systems. Minimal\nLICA plaque." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is a dominant partially circumscribed oval mass in the upper outer right\nanterior breast. 2 smaller partially circumscribed masses are identified in\nthe lower, central and slightly lower, slightly inner right breast at\nposterior depth measuring 7 mm and 9 mm, respectively. In the left outer,\ncentral left breast at posterior depth, there are 2 low-density circumscribed\nmasses measuring up to 6 mm in size. The patient could not tolerate\nadditional mammographic views. Targeted breast ultrasound was attempted for\nfurther evaluation. There is no unexplained architectural distortion or\nsuspicious grouped microcalcifications in either breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the expected\nlocation of the mammographic masses. At 12 o'clock 2 cm from the nipple,\nthere is a circumscribed parallel hypoechoic mass measuring 1.7 x 1.7 x 0.5 cm\nwith internal vascularity and no dominant posterior features.\n\nEvaluation of additional masses at 3 o'clock and 6 o'clock in the right breast\nand 3 o'clock in the left breast could not be performed due to the patient's\nsymptoms.", + "output": "Incomplete evaluation due to patient symptoms. Within this limitation, a\ndominant mass in the right breast is indeterminate and, although it is not\nhighly suspicious based on imaging features for primary breast malignancy,\nbiopsy is recommended for definitive diagnosis given the patient's recent\ndiagnosis of adenocarcinoma of unknown origin.\n\nRECOMMENDATION(S): 1. Ultrasound-guided core biopsy of the dominant mass at\n12 o'clock in the right breast is recommended.\n2. Comparison to prior mammograms is necessary for complete evaluation of\nadditional masses on mammography, which were incompletely evaluated on today's\nexam due to the patient's symptoms.\n3. At the time of biopsy, evaluation of additional bilateral masses is\nrecommended to complete the diagnostic workup.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy. The above was emailed by Dr. ___ to Dr. ___ on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Right breast 12 o'clock 2 cm from the nipple is an oval hypoechoic mass\nmeasuring 1.3 x 1.4 x 0.5 cm right enlarged axillary lymph node with cortical\nthickening of 0.5 cm\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___,\nMD (___).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained. \nNext, a percutaneous HydroMark coil was deployed under ultrasound guidance. \nTwo additional passes with a 14 gauge Bard spring-loaded biopsy device were\nobtained. The needle was removed and hemostasis was achieved.\n\nAttention was then directed to the axilla. Using standard aseptic technique\nand 1% lidocaine for local anesthesia 3 passes were made with 22 gauge\nneedles. The specimen was placed in CytoLyte.\n\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and Cytology by ___, the technologist.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPostprocedure mammogram was deferred because of the ___ medical\ncondition.", + "output": "Technically successful US-guided core biopsy of the right breast lesion and\nultrasound-guided fine-needle aspiration of right axillary lymph node. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "Targeted ultrasound was performed of the left breast from the 1 o'clock\nposition through the 5 o'clock position without evidence of suspicious solid\nor cystic mass to correspond to the low density circumscribed masses in the\nlateral central left breast at posterior depth.\n\nTargeted ultrasound was performed of the right breast from the 2 o'clock\nposition through the 7 o'clock position without evidence of suspicious solid\nor cystic mass, to corresponds to the circumscribed masses in the lower\ncentral and lower inner right breast on prior mammogram.\n\nTargeted ultrasound was performed of the right breast at the 12 o'clock\nposition 2 cm from the nipple in the area of prior mammographic and\nsonographic mass. There is a 1.6 x 1.5 x 0.5 cm oval hypoechoic mass which is\nnot significantly changed in comparison to the prior study from ___,\nallowing for differences in measuring technique.\n\nTargeted ultrasound of the right axilla was performed demonstrating at least 2\nabnormal appearing right axillary lymph nodes with thickened cortex 4-5 mm.", + "output": "Right breast mass is suspicious.\n\nRight axillary lymph nodes are suspicious.\n\nNo sonographic abnormality in the location of bilateral mammographic\ncircumscribed masses, as above.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of right breast mass at 12\no'clock position as well as tissue sampling of 1 right axillary lymph node.\n\nSix-month mammographic follow-up of bilateral sonographically occult\ncircumscribed masses. We are attempting to obtain prior outside imaging for\ncomparison and an addendum will be made upon review of prior imaging.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. Findings and recommendation were transmitted to Dr.\n___ by the critical results communication system at 15:46 ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of 44/5\ncm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n39/8 cm/sec in its proximal portion, 67/10 cm/sec in its mid portion and 56/11\ncm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 63cm/sec.\nThe vertebral artery has peak systolic velocity of 44 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.5.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous atherosclerotic plaque\nin the internal carotid artery with mild homogeneous plaque in the left\nexternal carotid artery.\nThe left common carotid artery had peak systolic/diastolic velocities of 59/8\ncm/sec.\nThe left internal carotid artery had peak systolic/diastolic velocities of\n98/16 cm/sec in its proximal portion, 48/13 cm/sec in its mid portion and\n48/10 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 99cm/sec.\nThe vertebral artery has peak systolic velocity of 39 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.7.", + "output": "Mild heterogeneous plaque burden on the right. Moderate heterogeneous plaque\nburden on the left. Less than 40% stenosis of bilateral internal carotid\narteries." + }, + { + "input": "A biopsy clip is visualized within an approximately 6 mm hypoechoic mass\nwithin the right axilla.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: The procedure was performed by Dr. ___ MD. (___).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a percutaneous HydroMark coilclip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: MLO view confirms the HydroMARK coil clip within\nthe known malignancy.", + "output": "Technically successful US-guided clip placement of right breast cancer." + }, + { + "input": "A biopsy clip is visualized within an approximately 6 mm hypoechoic mass\nwithin the right axilla.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: The procedure was performed by Dr. ___ MD. (___).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a percutaneous HydroMark coilclip was deployed under ultrasound\nguidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: MLO view confirms the HydroMARK coil clip within\nthe known malignancy.", + "output": "Technically successful US-guided clip placement of right breast cancer." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nRight breast skin thickening is noted. An asymmetry in present in the lower\ninner left breast only seen on the MLO view, which persists on additional\nimages. This was correlated clinically, and corresponded to an EKG leads on\nthe patient's inferior left breast. The EKG lead was removed, in the left\nbreast was re-imaged which demonstrated resolution of the left breast\nasymmetry. There are no spiculated masses, suspicious grouped\nmicrocalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast from ___ o'clock\n1-8 cm from the nipple, corresponding to the area of erythema and pain as\nindicated by the patient, demonstrates no solid mass or fluid collection. \nThere is moderate skin thickening and edema.", + "output": "Skin thickening and edema, without a focal collection to suggest abscess.\nNo mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nRight breast skin thickening is noted. An asymmetry in present in the lower\ninner left breast only seen on the MLO view, which persists on additional\nimages. This was correlated clinically, and corresponded to an EKG leads on\nthe patient's inferior left breast. The EKG lead was removed, in the left\nbreast was re-imaged which demonstrated resolution of the left breast\nasymmetry. There are no spiculated masses, suspicious grouped\nmicrocalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast from ___ o'clock\n1-8 cm from the nipple, corresponding to the area of erythema and pain as\nindicated by the patient, demonstrates no solid mass or fluid collection. \nThere is moderate skin thickening and edema.", + "output": "Skin thickening and edema, without a focal collection to suggest abscess.\nNo mammographic evidence of malignancy.\n\nRECOMMENDATION(S): Age and risk appropriate mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6.3 L of yellow straw-coloredfluid was removed and sent for\nthe requested laboratory analysis.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, personally supervised the procedure,\nsubsequently reviewing and has agreed with the preliminary findings.", + "output": "Uneventful diagnostic and therapeutic paracentesis yielding 6.3 L of yellow\nstraw-colored ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right\nlowerquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ ___ catheter was advanced into the largest fluid pocket in the\nright lower quadrant and 7 L of straw-colored, cloudy ascites fluid was\nremoved.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ was present for and personally supervised the entirety of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated ultrasound-guided therapeutic paracentesis via a right lower\nquadrant approach yielding 7 L of straw-colored, cloudy ascites fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA pre-procedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 7.5 L of cloudy, yellow, chylous-appearing fluid was\nremoved.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "7.5 L of cloudy, yellow, chylous-appearing fluid was removed from the RLQ\nunder ultrasound guidance. The appearance raises the question of a component\nof lymph." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 78 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 79, 116, and 105 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 50 cm/sec.\nThe ICA/CCA ratio is 1.5.\nThe external carotid artery has peak systolic velocity of 84 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 67 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 33, 64, and 83 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 37 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 59 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "<40% stenosis in the bilateral ICAs." + }, + { + "input": "Right innominate artery: Filling of the common carotid and subclavian with no\nstenosis.\n\nRight subclavian artery: Vessel caliber smooth regular. There is filling into\nthe thyrocervical trunk, vertebral artery as well as internal mammary artery.\n\nRight vertebral artery: Vasospasm is unchanged from the angiogram performed on\n___. There is filling of the bilateral superior cerebellar\narteries. Again there is retrograde flow into the left vertebral artery\nfilling the left posterior inferior cerebellar artery as well as the fusiform\naneurysm.\n\nRight vertebral artery following coil embolization: There are some areas spasm\nalong the intermediate catheter. The previously seen filling fusiform\naneurysm is no longer present on repeat angiogram. There is no filling of the\nleft posterior inferior cerebellar artery. Retrograde filling of the distal\nV4. No thromboembolic complications are identified. Normal venous phase", + "output": "1. Coil embolization of the left V4 fusiform aneurysm\n2. Expected occlusion of left posterior inferior cerebellar artery\n\nRECOMMENDATION(S):\n1. Continue ICU care for vasospasm and hydrocephalus" + }, + { + "input": "Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.\n\nRight vertebral artery: Vessel caliber smooth regular. There is filling of\nthe right posterior inferior cerebellar artery. There is filling of bilateral\nanterior inferior cerebellar arteries and bilateral superior cerebellar\narteries and left posterior cerebral artery and it's distal territory. The\nright posterior cerebral artery is fetal in orign as seen on the previous\nangiogram. There is and minimal retrograde filling into the proximal portion\nof the left vertebral artery and appears to be filling the left posterior\ninferior cerebellar artery past the coiled aneurysm. There is no filling of\nthe fusiform aneurysm that was previously treated. No new aneurysms or AVMs\nare identified. Normal arterial, capillary, and venous phase.\n\nLeft subclavian artery, cervical view: Vessel caliber smooth regular. There\nis filling of subclavian artery filling into the thyrocervical trunk ,the\ninternal mamillary artery and filling of the cervical vertebral artery and\nmuscular branches. There is no filling of the intracranial portion of the\nvertebral artery which is expected following coil embolization more distally.", + "output": "No filling of the left V4 vertebral artery segment. The previously seen left\nintracranial dissecting left vertebral artery no longer fills. The left ___\nfills retrograde through the right vertebral artery past the coiled aneurysm\nsegment.\n\nRECOMMENDATION(S):\n1. No further angiographic follow up required." + }, + { + "input": "Right subclavian artery: Vessel caliber smooth and regular there is filling of\nthe right vertebral artery right internal mammary artery and thyrocervical\ntrunk.\n\nRight vertebral artery: Vessel patency smooth and regular. There is\nretrograde flow into the left distal vertebral artery to the origin of the\nposterior-inferior cerebellar artery. However there is no filling of the left\nposterior inferior cerebellar artery from the right vertebral artery\ninjection. There is filling of the right posterior inferior cerebellar\nartery, bilateral anterior inferior cerebellar arteries. There is also\nfilling of bilateral superior cerebellar arteries. There is no filling of\nbilateral P1 vessels from this injection which is consistent with bilateral\nfetal posterior communicating arteries. There is filling of the anterior\nspinal artery as well as lateral spinal arteries. No aneurysms or\narteriovenous malformations are identified. Normal venous phase\n\nRight innominate artery: There is filling of the right common carotid artery\nand subsequent filling of the right internal and external carotid arteries. \nThere is filling of the right subclavian, left vertebral and thyrocervical\ntrunk.\n\nRight common carotid artery: Vessel caliber smooth and regular contour. There\nis filling of the internal and external carotid arteries. No stenosis is\nidentified using NASCET criteria.\n\nRight internal carotid artery fills well along the cervical, petrous,\ncavernous and supraclinoid portion. There is filling of the middle cerebral\nand anterior cerebral arteries. A fetal posterior communicating artery is\nidentified supplying the posterior cerebral artery distribution. There is\nopacification of the anterior communicating artery filling the left A1 and\nfilling partially the left M1. No intracranial ICA stenosis is identified. \nNo aneurysms or arteriovenous malformations identified. Normal venous phase.\n\nLeft internal carotid artery: Vessel caliber smooth and regular. There is\nopacification of the middle cerebral, anterior cerebral arteries. A left\nfetal posterior communicating artery is identified filling the posterior\ncerebral artery is distribution. There is cross filling across the anterior\ncommunicating artery into the right A2 and distal anterior cerebral artery\ndistribution. No intracranial ICA stenosis is identified. No aneurysm\narteriovenous malformation is identified. Normal venous phase.\n\nLeft vertebral artery: Vessel caliber smooth and regular. There is\nopacification of spinal arteries and left posterior inferior cerebral artery.\nHowever filling of the left posterior inferior cerebellar artery is late as\nthere is slow contrast filling from the vertebral injection. Previously seen\n5.8 mm x 13 mm fusiform aneurysm on outside hospital CTA is no longer\nidentified. There appears to be thrombus formation and occlusion of the\ndistal left vertebral artery with subsequent stasis of contrast following\ncontrast injection without filling into the basilar artery. No other aneurysm\nis identified nor are any arteriovenous malformations identified. Normal\nspinal venous phases identified venous phase not seen from the left posterior\ninferior cerebral artery.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "Previously seen 5.8 mm x 13 mm left distal vertebral artery fusiform aneurysm\nis no longer seen on angiography.\n\nLeft vertebral artery applies occluded at origin ___ and the ___ fills\nslowly on left side.\nRight verterbal artery retrogradely fills the distal left vertebral artery\nwithout filling the aneurysm.\n\nBilateral fetal type posterior communicating arteries\n\nRECOMMENDATION(S):\n1. Neuro ICU admission, continue to watch for vasospasm.\n2. External ventricular drain placement\n3. Repeat CT angiography to evaluate aneurysm occlusion." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque in the right ICA.\nThe peak systolic velocity in the right common carotid artery is 125 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 123, 97, and 83 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 68 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque in\nthe left ICA.\nThe peak systolic velocity in the left common carotid artery is 79 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 72, 77, and 75 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 84 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate heterogeneous atherosclerotic plaque in the right ICA resulting in\n40-59% stenosis.\n\n2. Mild heterogeneous atherosclerotic plaque in the left ICA resulting in the\nleft and 40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 84, 79, and 106 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is 1.8.\nThe external carotid artery has peak systolic velocity of 71 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 65 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 136, 98, and 89 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 2.1.\nThe external carotid artery has peak systolic velocity of 156 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Findings consistent with less than 40% stenosis of the right ICA and 40-59%\nstenosis of the left ICA. Accounting for differences in technique, this is\nlikely unchanged in comparison the prior study." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 79.5 cm/s / 18.6 cm/s\nCCA Distal: 77.7 cm/s / 19 cm/s\nICA ___: 105 cm/s / 28.6 cm/s\nICA Mid: 93.8 cm/s / 29.2 cm/s\nICA Distal: 95.1 cm/s / 27.3 cm/s\nECA: 72.1 cm/s\nVertebral: 98.2 cm/s\n\nICA/CCA Ratio: 1.35\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 87 cm/s / 20.5 cm/s\nCCA Distal: 63.4 cm/s / 18 cm/s\nICA ___: 87.6 cm/s / 28 cm/s\nICA Mid: 104 cm/s / 32.3 cm/s\nICA Distal: 114 cm/s / 34.3 cm/s\nECA: 39.5 cm/s\nVertebral: 77 cm/s\n\nICA/CCA Ratio: 1.8\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA 40-59% stenosis.\n\nWhen compared to ___, the findings on the right are similar. The\nestimated percent stenosis of the left ICA is similar, however, highest peak\nsystolic velocity is now seen in the distal ICA rather than the proximal ICA." + }, + { + "input": "Targeted ultrasound of the left breast in the area of palpable clinical\nconcern was performed which demonstrated no solid or cystic mass.", + "output": "No specific sonographic correlate to the palpable lump felt on clinical breast\nexam.\n\nRECOMMENDATION(S): Clinical follow-up for the palpable lump. Final patient\ndisposition should be based on clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. The parenchymal pattern is unchanged from prior exams.\n\nRIGHT BREAST ULTRASOUND: The upper outer right breast was scanned as directed\nby the patient. No abnormality is identified.", + "output": "No imaging correlate for the area of clinical concern in the upper outer right\nbreast. No evidence for malignancy in either breast.\n\nRECOMMENDATION(S): Further management for the area of clinical concern in the\nright breast should be based on the clinical assessment. Age and risk\nappropriate mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. The parenchymal pattern is unchanged from prior exams.\n\nRIGHT BREAST ULTRASOUND: The upper outer right breast was scanned as directed\nby the patient. No abnormality is identified.", + "output": "No imaging correlate for the area of clinical concern in the upper outer right\nbreast. No evidence for malignancy in either breast.\n\nRECOMMENDATION(S): Further management for the area of clinical concern in the\nright breast should be based on the clinical assessment. Age and risk\nappropriate mammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nIn the right breast, there is an oval well-circumscribed mass in the outer\nlower quadrant at posterior depth measuring 0.8 cm. In the left breast, the\nquestioned asymmetry in the lower breast is not well appreciated on the\ncurrent study. There is no architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of both breasts were done.\n\nLeft breast: At ___ o'clock and 1 cm from the nipple, there is a simple cyst\nmeasuring 0.4 x 0.3 x 0.4 cm. At 8 o'clock and 2 cm from the nipple, there is\na simple cyst measuring 0.7 x 0.4 x 0.7 cm. Adjacent to the aforementioned\nsimple cyst at ___ o'clock 2 cm from nipple, there is a smaller simple cyst\nmeasuring 0.3 x 0.2 x 0.3 cm. 1 of these correlates with the mammographic\nfinding.\n\nRight breast: Innumerable simple and complicated cysts are seen. At ___\no'clock and 2 cm from the nipple, there are two adjacent simple cysts\nmeasuring 0.7 x 0.3 x 0.6 cm and 0.9 x 0.7 x 0.3 cm, respectively. 1 of these\nlikely correlates to the mammographic finding. At ___ o'clock and 4 cm from\nthe nipple, there is a well-circumscribed oval hypoechoic mass the measuring\n0.4 x 0.3 x 0.3 cm with increased through transmission representing a\ncomplicated cyst.", + "output": "Multiple simple and complicated cysts in both breasts. No evidence of\nmalignancy.\n\nRECOMMENDATION(S): Annual screening mammography\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere diffuse benign-appearing calcifications within both breasts. There are\nskin markers denoting areas of prior surgery within the upper outer right\nbreast and upper outer left breast. There are multiple similar appearing\nround low-density circumscribed masses seen within both the right and left\nbreast, 1 of which appears to correspond to palpable abnormality at the 10\no'clock position right breast as noted by skin marker. There are no suspicious\ngrouped microcalcifications or unexplained architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasounds of the right breast performed at 10\no'clock and 12 o'clock at sites of reported palpable abnormality. At the 10\no'clock position right breast 7 cm from the nipple there is a 2.0 x 1.1 x 2.0\ncm hypoechoic circumscribed oval mass with posterior acoustic enhancement and\nno significant internal color flow. At the 12 o'clock position right breast 7\ncm from the nipple corresponding to second palpable abnormality there is a 1.2\nx 0.9 x 1.2 cm predominantly anechoic circumscribed round mass with posterior\nacoustic enhancement which most likely represents a benign cyst.", + "output": "1. 2 cm hypoechoic mass 10 o'clock right breast 7 cm from the nipple\ncorresponding to palpable abnormality. Imaging characteristics favor a benign\nfibroadenoma however no prior images are available to ensure stability is\ntherefore ultrasound-guided biopsy is recommended at this time for\nconfirmation.\n2. Probably benign 1.2 cm minimally complicated cyst at 12 o'clock right\nbreast 7 cm from the nipple. If biopsy results of mass at the 10 o'clock\nposition are benign then six-month follow-up ultrasound is recommended to\nensure stability.\n3. Multiple additional benign-appearing masses noted within the right and\nleft breast on screening mammogram consistent with a benign process.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the palpable 2 cm mass 10:00\nposition right breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient with the aid of an interpreter over the phone who agrees with this\nplan. She was given information to schedule her biopsy. The impression and\nrecommendation above was entered by Dr. ___ on ___ at\n17:19 into the Department of Radiology critical communications system for\ndirect communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere diffuse benign-appearing calcifications within both breasts. There are\nskin markers denoting areas of prior surgery within the upper outer right\nbreast and upper outer left breast. There are multiple similar appearing\nround low-density circumscribed masses seen within both the right and left\nbreast, 1 of which appears to correspond to palpable abnormality at the 10\no'clock position right breast as noted by skin marker. There are no suspicious\ngrouped microcalcifications or unexplained architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasounds of the right breast performed at 10\no'clock and 12 o'clock at sites of reported palpable abnormality. At the 10\no'clock position right breast 7 cm from the nipple there is a 2.0 x 1.1 x 2.0\ncm hypoechoic circumscribed oval mass with posterior acoustic enhancement and\nno significant internal color flow. At the 12 o'clock position right breast 7\ncm from the nipple corresponding to second palpable abnormality there is a 1.2\nx 0.9 x 1.2 cm predominantly anechoic circumscribed round mass with posterior\nacoustic enhancement which most likely represents a benign cyst.", + "output": "1. 2 cm hypoechoic mass 10 o'clock right breast 7 cm from the nipple\ncorresponding to palpable abnormality. Imaging characteristics favor a benign\nfibroadenoma however no prior images are available to ensure stability is\ntherefore ultrasound-guided biopsy is recommended at this time for\nconfirmation.\n2. Probably benign 1.2 cm minimally complicated cyst at 12 o'clock right\nbreast 7 cm from the nipple. If biopsy results of mass at the 10 o'clock\nposition are benign then six-month follow-up ultrasound is recommended to\nensure stability.\n3. Multiple additional benign-appearing masses noted within the right and\nleft breast on screening mammogram consistent with a benign process.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of the palpable 2 cm mass 10:00\nposition right breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient with the aid of an interpreter over the phone who agrees with this\nplan. She was given information to schedule her biopsy. The impression and\nrecommendation above was entered by Dr. ___ on ___ at\n17:19 into the Department of Radiology critical communications system for\ndirect communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the right breast at 10 o'clock 7 cm from the nipple, there is an ovoid,\npredominantly anechoic lesion measuring 1.7 x 1.2 x 1.5 cm.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained with an\ninterpreter.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___. ___, M.D. and ___, M.D..\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the lesion and 2 cc of\nmilky fluid was aspirated. The fluid was discarded due to lack of suspicion.\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast cyst.\nStandard post care instructions were provided to the patient.", + "output": "Technically successful US-guided aspiration of the right breast cyst.\n\nAspiration was offered of the additional probable cyst at 12 o'clock 7 cm from\nthe nipple however the patient declined at this time and prefers six-month\nfollow-up.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation.\n\nRECOMMENDATION(S): The patient is due for a 6-month follow-up of the second\npalpable abnormality at 12 o'clock 7 cm from the nipple and was given\ninformation to schedule this appointment." + }, + { + "input": "In the right breast, at the 12 o'clock position, 7 cm from the nipple, there\nis a circumscribed mass, measuring 0.8 x 0.9 x 0.9 cm with a small amount of\nlayering debris. There is no demonstrable internal vascularity or posterior\nshadowing. Appearances are similar to slightly smaller compared to ___. This most likely represents a complicated cyst.", + "output": "Probably benign mass in the right breast at 12:00 o'clock, 7 cm from the\nnipple, likely complicated cyst.\n\nRECOMMENDATION(S): The patient will be due for annual mammography in ___. Recommend reassessment of this mass with ultrasound at the same time.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She agrees with the plan.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "The right kidney measures 12.4 cm. The left kidney measures 13.1 cm. There is\nno hydronephrosis, stones or masses bilaterally. Renal echogenicity and\ncorticomedullary architecture is within normal limits. There is a 6.8 x 5.9 x\n6.3 cm simple cyst in the interpolar region of the right kidney. There is a\n2.2 x 2.3 x 2.3 cyst in the upper pole of the left kidney. The bladder is\nonly minimally distended but appears normal.", + "output": "Simple bilateral renal cysts. Otherwise normal renal ultrasound." + }, + { + "input": "Loculated hypoechoic collection within the subcutaneous tissues of the\nanterior abdominal wall measuring up to 6.4 cm. This collection was targeted\nfor ultrasound-guided aspiration.", + "output": "Technically successful ultrasound-guided aspiration of the anterior abdominal\nwall fluid collection with 40 cc of serosanguineous fluid aspirated." + }, + { + "input": "Targeted ultrasound of the left breast was performed. The left breast was\nscanned from ___ o'clock extending to the axilla. No discrete solid or cystic\nmass was seen.", + "output": "Unremarkable targeted left breast ultrasound.\n\nRECOMMENDATION(S): Final disposition of pain should be based on clinical\nevaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "The waveforms bilaterally have diffuse late systolic blunting consistent with\nknown diagnosis of critical aortic stenosis.\n\nRIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 85, 85, and 86. Cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 95 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 74 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 71, 98, and 91 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 35 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 77 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral mild atherosclerotic plaque with less than 40% bilaterally. \nAntegrade vertebral flow." + }, + { + "input": "There is normal compressibility, flow, and augmentation of the bilateral\ncommon femoral, femoral, and popliteal veins. Normal color flow and\ncompressibility are demonstrated in the posterior tibial and peroneal veins.\n\nThere is normal respiratory variation in the common femoral veins bilaterally.\n\nNo evidence of medial popliteal fossa (___) cyst.", + "output": "No evidence of deep venous thrombosis in the right or left lower extremity\nveins." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 108 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 84, 61, and 67 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 40 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 89 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 101 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 68, 113, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 62 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 62 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No significant stenosis involving the right or left internal carotid arteries." + }, + { + "input": "At the 9 o'clock position 1 cm from the nipple, a hypoechoic lesion is again\nseen measuring 4 x 3 x 3 mm, unchanged from prior exam, suggestive of a benign\netiology. No lesion is seen at the 9 o'clock position 4 cm from the nipple,\nthe site of the previously seen papilloma.", + "output": "6 month stability of a probably benign hypoechoic lesion in the right breast.\n\nRECOMMENDATION: Followup diagnostic mammogram and right breast ultrasound in\n6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nFocal asymmetry in the upper-outer left breast does not persist on spot\ncompression views, suggestive of overlapping fibroglandular tissue. Nodular\nasymmetry in the right outer breast, at anterior depth, is best appreciated on\nthe CC view. There is no spiculated mass, architectural distortion or\nsuspicious grouped microcalcifications in either breast. There is a ribbon\nclip in the upper-outer right breast corresponding to previously biopsied\npapilloma. Vascular calcifications are noted.\n\nBREAST ULTRASOUND:\nTargeted ultrasound exam of the right breast was performed. At 9 o'clock\nposition, 1 cm from the nipple, there is a 0.4 x 0.3 x 0.3 cm oval anechoic\nmass with circumscribed margins, posterior acoustic enhancement and no\ninternal vascularity, compatible with a cyst. This is unchanged since ___ exam and is felt to correspond to nodular asymmetry on concurrent\nmammograms. No new suspicious cystic or solid mass identified.", + "output": "1. One year stability of probable benign right breast nodular asymmetry,\nwhich is felt to correspond to a cyst on ultrasound. One year followup is\nrecommended to ensure stability.\n\nRECOMMENDATION: Diagnostic bilateral mammography and right breast ultrasound\n___ year.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRIGHT BREAST: A clip corresponding to prior biopsy in the upper outer right\nbreast is present without an associated mass. There are benign-appearing\ncoarse and vascular calcifications. There is no mass, area of unexplained\narchitectural distortion, or suspicious grouped microcalcifications.\n\nLEFT BREAST: Within the slightly medial inferior left breast at mid to\nanterior depth, there is a focal 9 mm well circumscribed lobulated mass\nfurther evaluated by ultrasound. There is no unexplained architectural\ndistortion or suspicious grouped microcalcifications. Coarse benign-appearing\ncalcifications and vascular calcifications are noted.\n\nBREAST ULTRASOUND: Targeted ultrasound of the medial left breast was\nperformed. At the 9 o'clock position approximately 2 cm from the nipple,\nthere is a 0.7 x 0.5 x 0.3 cm probable cluster of microcysts. There is no\ninternal vascularity. There is no definite solid component. This is felt to\ncorrespond to mammographic abnormality.", + "output": "Probable cluster cysts within the medial left breast warrants repeat breast\nultrasound in 6 months time to document anticipated stability.\n\nRECOMMENDATION(S): Left breast ultrasound in 6 months time to document\nanticipated stability of cluster of microcysts within the medial left breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The impression and recommendation above was entered by Dr. ___\n___ on ___ at 14:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRIGHT BREAST: A clip corresponding to prior biopsy in the upper outer right\nbreast is present without an associated mass. There are benign-appearing\ncoarse and vascular calcifications. There is no mass, area of unexplained\narchitectural distortion, or suspicious grouped microcalcifications.\n\nLEFT BREAST: Within the slightly medial inferior left breast at mid to\nanterior depth, there is a focal 9 mm well circumscribed lobulated mass\nfurther evaluated by ultrasound. There is no unexplained architectural\ndistortion or suspicious grouped microcalcifications. Coarse benign-appearing\ncalcifications and vascular calcifications are noted.\n\nBREAST ULTRASOUND: Targeted ultrasound of the medial left breast was\nperformed. At the 9 o'clock position approximately 2 cm from the nipple,\nthere is a 0.7 x 0.5 x 0.3 cm probable cluster of microcysts. There is no\ninternal vascularity. There is no definite solid component. This is felt to\ncorrespond to mammographic abnormality.", + "output": "Probable cluster cysts within the medial left breast warrants repeat breast\nultrasound in 6 months time to document anticipated stability.\n\nRECOMMENDATION(S): Left breast ultrasound in 6 months time to document\nanticipated stability of cluster of microcysts within the medial left breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The impression and recommendation above was entered by Dr. ___\n___ on ___ at 14:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At 9:00 position 2 cm from the nipple there is a 5 x 3 x 3 mm hypoechoic\ncircumscribed mass, slightly smaller in size compared to prior measurements of\n7 x 5 x 3.", + "output": "Apparent interval decrease in size of a probably benign mass at 9:00 position\nin left breast.\n\nRECOMMENDATION(S): 6 months mammographic follow-up at the time of annual\nbilateral mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere has been interval decrease in size of oval, circumscribed isodense mass\nwithin the slightly medial inferior left breast, now measuring 6 mm,\npreviously 10 mm. Otherwise, there is no new suspicious mass, unexplained\narchitectural distortion, or suspicious grouped microcalcifications within\neither breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. There has been\ninterval decrease in size of the hypoechoic mass at the 9 o'clock position of\nthe left breast approximately 2 cm from the nipple corresponding to the\nmammographic abnormality of concern, now measuring 2 x 2 x 2 mm, previously\nmeasuring 5 x 3 x 3 mm. This represents a cyst decreasing in size and was\ndecreased in size on the previous examination. Otherwise, no new suspicious\nabnormality is identified.", + "output": "1. Continued interval decrease in size of left breast mass, representing a\ncyst. No further imaging surveillance is warranted.\n2. No mammographic evidence to suggest malignancy within either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere has been interval decrease in size of oval, circumscribed isodense mass\nwithin the slightly medial inferior left breast, now measuring 6 mm,\npreviously 10 mm. Otherwise, there is no new suspicious mass, unexplained\narchitectural distortion, or suspicious grouped microcalcifications within\neither breast.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed. There has been\ninterval decrease in size of the hypoechoic mass at the 9 o'clock position of\nthe left breast approximately 2 cm from the nipple corresponding to the\nmammographic abnormality of concern, now measuring 2 x 2 x 2 mm, previously\nmeasuring 5 x 3 x 3 mm. This represents a cyst decreasing in size and was\ndecreased in size on the previous examination. Otherwise, no new suspicious\nabnormality is identified.", + "output": "1. Continued interval decrease in size of left breast mass, representing a\ncyst. No further imaging surveillance is warranted.\n2. No mammographic evidence to suggest malignancy within either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nIn the upper outer left breast there is a 2 cm area of architectural\ndistortion which persists on additional imaging.\nBenign-appearing calcifications and vascular calcifications are noted. There\nis no suspicious mass or grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. At\n2 o'clock, 6 cm from the nipple there is a 1.5 x 1.7 x 1.1 cm hypoechoic,\nanti-parallel, irregular, spiculated mass with posterior shadowing and an\nechogenic halo which corresponds to the area of architectural distortion on\nmammography. There is no significant internal vascularity.", + "output": "Suspicious 1.7 cm mass in the upper outer left breast for which\nultrasound-guided core biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the upper outer left\nbreast mass.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Her biopsy was performed immediately after this exam.\n\n Findings emailed to ___, MD by ___, MD on ___\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nIn the upper outer left breast there is a 2 cm area of architectural\ndistortion which persists on additional imaging.\nBenign-appearing calcifications and vascular calcifications are noted. There\nis no suspicious mass or grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. At\n2 o'clock, 6 cm from the nipple there is a 1.5 x 1.7 x 1.1 cm hypoechoic,\nanti-parallel, irregular, spiculated mass with posterior shadowing and an\nechogenic halo which corresponds to the area of architectural distortion on\nmammography. There is no significant internal vascularity.", + "output": "Suspicious 1.7 cm mass in the upper outer left breast for which\nultrasound-guided core biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the upper outer left\nbreast mass.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Her biopsy was performed immediately after this exam.\n\n Findings emailed to ___, MD by ___, MD on ___\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Again seen in the left breast at 2 o'clock 6 cm from the nipple is a\nhypoechoic mass. This is the mass that is the target for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by ___,\nM.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "Again seen in the left breast at 2 o'clock 6 cm from the nipple is a\nhypoechoic mass. This is the mass that is the target for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: N. ___, N.P. The procedure was supervised by ___,\nM.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations." + }, + { + "input": "The spleen measures 12.8 cm. A fluid collection within the spleen measures\n5.2 x 6.7 by 3.3 cm and contains multiple foci of internal air. With the\npatient in the right lateral decubitus position, this collection is\npotentially accessible by ultrasound guidance (image 12). There is a small\nleft pleural effusion.", + "output": "Air containing fluid collection within the spleen, which might represent an\nabscess, is potentially accessible by ultrasound guidance for aspiration and\nor drainage. Small left pleural effusion." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 38, 45, and 91 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 102 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 79 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 84, 94, and 84 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 31 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 101 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the bilateral internal carotid arteries." + }, + { + "input": "Corresponding to the large left hepatic cyst seen on prior CT, there is a 9.4\ncm anechoic structure within the left hepatic lobe with internal nonvascular\nseptations. Post aspiration imaging demonstrates collapse of the cavity.", + "output": "Successful ultrasound-guided aspiration of a 9.4 cm left hepatic cyst with\ncollapse of the cavity on post aspiration imaging. 350 cc of dark non\npurulent fluid was aspirated with a sample sent for microbiology and cytology\nevaluation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic paracentesis\nLocation: right lower quadrant\nFluid: 20 mL of serosanguinous fluid\nSamples: Fluid samples were submitted to the laboratory for the requested\nanalysis.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and verbal consent was obtained due to COVID-19 precautions.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Uncomplicated ultrasound-guided paracentesis. Fluid samples were obtained and\nsent to the lab for analysis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 47, 55, and 55 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.95.\nThe external carotid artery has peak systolic velocity of 55 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 68 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 51, 6 6, and 66 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No plaque or hemodynamically significant stenosis of the right carotid artery.\n\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed at the 8:00 position\napproximately 5-6 cm from the nipple in the area of concern as indicated by\nthe patient. No discrete suspicious solid or cystic masses are identified.", + "output": "No specific mammographic or sonographic findings of malignancy identified the\nleft breast.\nNo specific mammographic evidence of malignancy in the right breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.5 L of clear, straw-colored fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis with removal of 1.5 L of straw-colored ascites." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin. The skin was then cleaned and a dry sterile dressing was applied.\nThere was no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 11\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe initially noted a 7 mm low-density oval mass in the inner left breast is\npliable on spot compression mammography but does not efface completely. There\nis no associated calcification or architectural change. A second smaller\ncircumscribed nodule is seen more superficially and slightly closer to the\nnipple as well.\n\nBREAST ULTRASOUND: Ultrasound of the left inner breast was performed. In the\n9 o'clock location 7 cm from the nipple posteriorly there is a 7 x 3 x 5 mm\nsimple cyst or cluster of simple cysts which would correspond in size, shape\nand location to the initially noted mammographic asymmetry. A second smaller\nsimple cyst is identified more superficially in the 9 o'clock location 3 cm\nfrom the nipple measuring 4 x 4 x 2 mm corresponding to the additional\ncircumscribed nodule on the mammogram.", + "output": "A 7 mm simple cyst in the left breast at 9 o'clock corresponds to the\ninitially noted mammographic asymmetry. No suspicious findings.\n\nRECOMMENDATION(S): Routine age and risk appropriate mammography is\nrecommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 51, 49, and 40 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 44 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 55, 59, and 47 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.8.\nThe external carotid artery has peak systolic velocity of 72 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No atherosclerotic plaque or stenosis within the bilateral carotid\nvasculature." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 85.1 cm/s / 12.4 cm/s\nCCA Distal: 78.9 cm/s / 14 cm/s\nICA ___: 78.7 cm/s / 11 cm/s\nICA Mid: 62.2 cm/s / 17.1 cm/s\nICA Distal: 63.4 cm/s / 15.9 cm/s\nECA: 113 cm/s\nVertebral: 42.8 cm/s\n\nICA/CCA Ratio: 1\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 77.4 cm/s / 19 cm/s\nCCA Distal: 73.7 cm/s / 17 cm/s\nICA ___: 54.4 cm/s / 10 cm/s\nICA Mid: 63.9 cm/s / 19.6 cm/s\nICA Distal: 84.5 cm/s / 21.1 cm/s\nECA: 129 cm/s\nVertebral: 46.5 cm/s\n\nICA/CCA Ratio: 1.15\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Mild bilateral heterogeneous atherosclerotic plaque.\nRight ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 72, 60, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 0.98.\nThe external carotid artery has peak systolic velocity of 81 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 36 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 39, 71, and 59 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 1.9.\nThe external carotid artery has peak systolic velocity of 36 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the internal carotid arteries bilaterally." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 86 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 73 cm/s, 57 cm/s, and 77 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.89.\nThe external carotid artery has peak systolic velocity of104 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 107 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 62 cm/s, 89 cm/s, and 76 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.82.\nThe external carotid artery has peak systolic velocity of 94 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the internal carotid arteries bilaterally." + }, + { + "input": "Targeted breast ultrasound of the inferior right breast and the lateral and\ninferior left breast were performed. There is minimal soft tissue thickening\nand mild subcutaneous edema throughout the imaged portion of both breasts\nhowever no underlying fluid collection is identified.", + "output": "Targeted ultrasound of the inferior right breast and lateral and inferior left\nbreast show soft tissue thickening and mild subcutaneous edema liver there is\nno underlying fluid collection identified in either breast." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and nodular\nwhich may obscure detection of small masses. The asymmetry in the left\naxillary tail is stable for ___ years favoring a benign process such as\naccessory breast tissue. Continued follow-up imaging in one year seems\nreasonable at this time. In the slightly upper inner left breast at posterior\ndepth there is a circumscribed mass measuring 1.4 x 1 x 0.9 cm which was\nsubsequently imaged by ultrasound. No suspicious grouped calcifications or\narchitectural distortion are seen in either breast.\n\nUltrasound of the left breast from ___ o'clock 2-12 cm from the nipple in the\narea of concern on mammography was performed.\n\nAt 10 o'clock 10 cm from the nipple there is a cystic appearing mass measuring\n1.4 x 1.1 x 0.7 cm with a dominant simple component superficially and a\nsmaller area of probable microcysts along the deeper portion that measures 0.7\nx 0.4 cm with some internal vascularity. Findings favor a benign process,\npossibly apocrine metaplasia. This is felt to likely correspond to the\nmammographic finding. Follow-up mammography and ultrasound in six months\nseems the most reasonable approach at this time.\n\nAt 12 o'clock 8 cm from the nipple there is a cystic appearing lesion which\nagain favors a benign finding, possibly apocrine metaplasia that measures 1 x\n0.9 x 0.5 cm. This can also be re-evaluated in six months.", + "output": "Two probable benign masses in the left breast at 10 o'clock and 12 o'clock for\nwhich a six-month follow-up mammogram and ultrasound seems reasonable at this\ntime.\n\nTwo year stability of probable benign left axillary asymmetry for which\ncontinued followup diagnostic mammography in one year seems reasonable at this\ntime..\n\nRECOMMENDATION(S): Left breast diagnostic mammogram and ultrasound in six\nmonths.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense and nodular\nwhich may obscure detection of small masses. The asymmetry in the left\naxillary tail is stable for ___ years favoring a benign process such as\naccessory breast tissue. Continued follow-up imaging in one year seems\nreasonable at this time. In the slightly upper inner left breast at posterior\ndepth there is a circumscribed mass measuring 1.4 x 1 x 0.9 cm which was\nsubsequently imaged by ultrasound. No suspicious grouped calcifications or\narchitectural distortion are seen in either breast.\n\nUltrasound of the left breast from ___ o'clock 2-12 cm from the nipple in the\narea of concern on mammography was performed.\n\nAt 10 o'clock 10 cm from the nipple there is a cystic appearing mass measuring\n1.4 x 1.1 x 0.7 cm with a dominant simple component superficially and a\nsmaller area of probable microcysts along the deeper portion that measures 0.7\nx 0.4 cm with some internal vascularity. Findings favor a benign process,\npossibly apocrine metaplasia. This is felt to likely correspond to the\nmammographic finding. Follow-up mammography and ultrasound in six months\nseems the most reasonable approach at this time.\n\nAt 12 o'clock 8 cm from the nipple there is a cystic appearing lesion which\nagain favors a benign finding, possibly apocrine metaplasia that measures 1 x\n0.9 x 0.5 cm. This can also be re-evaluated in six months.", + "output": "Two probable benign masses in the left breast at 10 o'clock and 12 o'clock for\nwhich a six-month follow-up mammogram and ultrasound seems reasonable at this\ntime.\n\nTwo year stability of probable benign left axillary asymmetry for which\ncontinued followup diagnostic mammography in one year seems reasonable at this\ntime..\n\nRECOMMENDATION(S): Left breast diagnostic mammogram and ultrasound in six\nmonths.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAgain seen is a circumscribed mass measuring approximately 1.3 cm in the upper\ninner breast corresponding to the mass at 10 o'clock on ultrasound being\nfollowed. Additionally there is a new 0.5 mm circumscribed mass anterior to\nthis mass which was further evaluated by ultrasound. The mass previously\nnoted at 12 o'clock is smaller mammographically. There is no suspicious\ngrouped microcalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the areas previously\nevaluated. At 10 o'clock 10 cm from the nipple there is a 1.0 x 0.9 x 1.4 cm\ncluster of cysts with a cluster of microcysts along the posterior portion\nwhich is similar to the previous study when it measured 1.1 x 0.8 x 1.4 cm. \nAt 12 o'clock 8 cm from the nipple there is a 0.6 x 0.3 x 0.6 cm cluster of\nmicrocysts which has decreased in size compared to the prior study when it\nmeasured 1.0 x 0.5 x 0.9 cm. At 10 o'clock 9 cm from the nipple there is a\n0.5 x 0.4 x 0.5 cm parallel hypoechoic mass without internal vascularity that\nhas the appearance of a cluster of microcysts. This is felt to correspond to\nthe new 0.5 cm mass in the inner breast on mammography. At 10 o'clock 9 cm\nfrom nipple also noted is a 0.4 x 0.4 x 0.3 cm circumscribed anechoic simple\ncyst", + "output": "1. 6 month stability of probably benign mass at 10 o'clock 10 cm from the\nnipple for which continued follow-up in 6 months with ultrasound is\nrecommended.\n2. Probably benign cluster of microcysts at 10 o'clock 9 cm from the nipple\nfor which six-month follow-up ultrasound is recommended.\n3. Interval decrease in size of cysts at 12 o'clock which no further imaging\nfollow-up is required.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and left breast ultrasound\nin 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nAgain seen is a circumscribed mass measuring approximately 1.3 cm in the upper\ninner breast corresponding to the mass at 10 o'clock on ultrasound being\nfollowed. Additionally there is a new 0.5 mm circumscribed mass anterior to\nthis mass which was further evaluated by ultrasound. The mass previously\nnoted at 12 o'clock is smaller mammographically. There is no suspicious\ngrouped microcalcifications or architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed in the areas previously\nevaluated. At 10 o'clock 10 cm from the nipple there is a 1.0 x 0.9 x 1.4 cm\ncluster of cysts with a cluster of microcysts along the posterior portion\nwhich is similar to the previous study when it measured 1.1 x 0.8 x 1.4 cm. \nAt 12 o'clock 8 cm from the nipple there is a 0.6 x 0.3 x 0.6 cm cluster of\nmicrocysts which has decreased in size compared to the prior study when it\nmeasured 1.0 x 0.5 x 0.9 cm. At 10 o'clock 9 cm from the nipple there is a\n0.5 x 0.4 x 0.5 cm parallel hypoechoic mass without internal vascularity that\nhas the appearance of a cluster of microcysts. This is felt to correspond to\nthe new 0.5 cm mass in the inner breast on mammography. At 10 o'clock 9 cm\nfrom nipple also noted is a 0.4 x 0.4 x 0.3 cm circumscribed anechoic simple\ncyst", + "output": "1. 6 month stability of probably benign mass at 10 o'clock 10 cm from the\nnipple for which continued follow-up in 6 months with ultrasound is\nrecommended.\n2. Probably benign cluster of microcysts at 10 o'clock 9 cm from the nipple\nfor which six-month follow-up ultrasound is recommended.\n3. Interval decrease in size of cysts at 12 o'clock which no further imaging\nfollow-up is required.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and left breast ultrasound\nin 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight: The right breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications.\nLeft: There is stable global asymmetric glandular tissue in the axillary tail\nand lower axilla. There has been an interval decrease in the size of the left\nbreast cysts in the upper inner quadrant. The left breast is without\nsuspicious dominant mass, unexplained architectural distortion or suspicious\ngrouped calcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left upper inner quadrant\nat 10 o'clock 10 cm from the nipple demonstrates a 1.0 x 0.6 x 0.7 cm cyst\nwith thin internal septations, without dominant vascularity, with some through\ntransmission and internal debris. This is smaller compared to the prior study\nwhen it measured 1.5 cm in greatest dimension, and is a benign finding.\nAt 10 o'clock 9 cm from the nipple there is a stable cluster of microcysts\nwhich measures 0.5 x 0.3 x 0.5 cm.\nThe prior resolving cyst at 12 o'clock 8 cm from the nipple is now 0.6 x 0.2 x\n0.6 cm (previously 1.0 x 0.5 x 1.0 cm), consistent with a benign entity.\n\nScanning of the left upper outer quadrant and axilla at ___ o'clock 10-20 cm\nfrom the nipple demonstrates a 4-5 cm patch of heterogeneous glandular tissue\ncontaining several simple cysts the largest of which is 1.1 cm. Overall, this\nappearance is consistent with an area of benign-appearing glandular tissue\nand/or fibrocystic change. There is no suspicious solid or cystic mass\nidentified.", + "output": "No specific evidence of malignancy in either breast.\nStable left upper outer quadrant global asymmetry. Interval decrease in the\nsize of the left breast cysts and microcysts in the upper inner quadrant,\nconsistent with benign findings.\n\nRECOMMENDATION(S): Return to annual screening.\nIn addition, the patient was given the breast Care Center phone number for\nfollow-up of left breast pain.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She notes that she is using evening Primrose oil with\nsome positive affect.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight: The right breast is without suspicious dominant mass, unexplained\narchitectural distortion or suspicious grouped calcifications.\nLeft: There is stable global asymmetric glandular tissue in the axillary tail\nand lower axilla. There has been an interval decrease in the size of the left\nbreast cysts in the upper inner quadrant. The left breast is without\nsuspicious dominant mass, unexplained architectural distortion or suspicious\ngrouped calcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound of the left upper inner quadrant\nat 10 o'clock 10 cm from the nipple demonstrates a 1.0 x 0.6 x 0.7 cm cyst\nwith thin internal septations, without dominant vascularity, with some through\ntransmission and internal debris. This is smaller compared to the prior study\nwhen it measured 1.5 cm in greatest dimension, and is a benign finding.\nAt 10 o'clock 9 cm from the nipple there is a stable cluster of microcysts\nwhich measures 0.5 x 0.3 x 0.5 cm.\nThe prior resolving cyst at 12 o'clock 8 cm from the nipple is now 0.6 x 0.2 x\n0.6 cm (previously 1.0 x 0.5 x 1.0 cm), consistent with a benign entity.\n\nScanning of the left upper outer quadrant and axilla at ___ o'clock 10-20 cm\nfrom the nipple demonstrates a 4-5 cm patch of heterogeneous glandular tissue\ncontaining several simple cysts the largest of which is 1.1 cm. Overall, this\nappearance is consistent with an area of benign-appearing glandular tissue\nand/or fibrocystic change. There is no suspicious solid or cystic mass\nidentified.", + "output": "No specific evidence of malignancy in either breast.\nStable left upper outer quadrant global asymmetry. Interval decrease in the\nsize of the left breast cysts and microcysts in the upper inner quadrant,\nconsistent with benign findings.\n\nRECOMMENDATION(S): Return to annual screening.\nIn addition, the patient was given the breast Care Center phone number for\nfollow-up of left breast pain.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She notes that she is using evening Primrose oil with\nsome positive affect.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\n\nThe right internal carotid artery has peak systolic velocities of 93 cm/sec in\nits proximal portion, 84 cm/sec in its mid portion and 83 cm/sec in its distal\nportion.\n\nThe right common carotid artery has peak systolic velocities of 106 cm/sec.\n\nThe right external carotid artery has peak systolic velocity of 84cm/sec.\n\nFlow in the right vertebral artery is antegrade.\n\nThe right ICA/CCA ratio is 0.87.\n\nLEFT:\n\nThe left internal carotid artery has peak systolic velocities of 82 cm/sec in\nits proximal portion, 92 cm/sec in its mid portion and 99 cm/sec in its distal\nportion.\n\nThe left common carotid artery has peak systolic velocities of 123 cm/sec.\n\nThe left external carotid artery has peak systolic velocity of 45cm/sec.\n\nFlow in the left vertebral artery is antegrade.\n\nThe left ICA/CCA ratio is 0.80.", + "output": "Normal carotid ultrasound." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mixed atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 50 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 65, 45, and 54 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 19 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 51 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 50 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 69, 41, and 38 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 27 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 82 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in the internal carotid arteries bilaterally. Note is\nmade of plaque in both internal carotid arteries which is more mixed in\nsonographic characteristics on the right and homogeneous on the left." + }, + { + "input": "Left lateral thigh hematoma.\n\nAspiration of 5 cc sanguinous fluid from the left lateral thigh hematoma.", + "output": "Left lateral thigh hematoma with removal of 5 cc sanguinous fluid, sent to\nmicrobiology." + }, + { + "input": "BREAST ULTRASOUND: Targeted ultrasound was performed. In the left breast at\nthe 8 o'clock position 8 cm from the nipple, there is a 6 x 6 x 3 mm\ncircumscribed oval hypoechoic mass with posterior acoustic enhancement, along\nthe inferomedial implant capsule. There is minimal hyperechoic content within\nthe mass.\n\nTissue density: A - The breast tissue is almost entirely fatty.\nThe patient is status post mastectomy. There is no suspicious mass,\nunexplained architectural distortion or suspicious grouped microcalcification.\nLeft breast implant is grossly intact. The metallic BB is not visualized on\nthe images, too far medial.", + "output": "Left breast mass is probably benign, most likely evolving fat necrosis or\nfibroadenoma.\n\nRECOMMENDATION(S): Options for further management were discussed with the\npatient, including short-term interval follow-up breast ultrasound, further\nevaluation with breast MRI to assess for definitive evidence of fat necrosis,\nultrasound-guided biopsy or surgical excision. The patient prefers to\nevaluate with breast MRI at the current time, however will discuss tissue\nsampling options with NP ___. If breast MRI non confirmatory and the\npatient does not desire tissue sampling, follow-up breast ultrasound\nrecommended in 6 months to assess stability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. Findings recommendations were reviewed by Dr. ___\nwith NP ___ at approximately 13:45 ___ by telephone with\nconfirmation.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BREAST ULTRASOUND: Targeted ultrasound was performed. In the left breast at\nthe 8 o'clock position 8 cm from the nipple, there is a 6 x 6 x 3 mm\ncircumscribed oval hypoechoic mass with posterior acoustic enhancement, along\nthe inferomedial implant capsule. There is minimal hyperechoic content within\nthe mass.\n\nTissue density: A - The breast tissue is almost entirely fatty.\nThe patient is status post mastectomy. There is no suspicious mass,\nunexplained architectural distortion or suspicious grouped microcalcification.\nLeft breast implant is grossly intact. The metallic BB is not visualized on\nthe images, too far medial.", + "output": "Left breast mass is probably benign, most likely evolving fat necrosis or\nfibroadenoma.\n\nRECOMMENDATION(S): Options for further management were discussed with the\npatient, including short-term interval follow-up breast ultrasound, further\nevaluation with breast MRI to assess for definitive evidence of fat necrosis,\nultrasound-guided biopsy or surgical excision. The patient prefers to\nevaluate with breast MRI at the current time, however will discuss tissue\nsampling options with NP ___. If breast MRI non confirmatory and the\npatient does not desire tissue sampling, follow-up breast ultrasound\nrecommended in 6 months to assess stability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. Findings recommendations were reviewed by Dr. ___\nwith NP ___ at approximately 13:45 ___ by telephone with\nconfirmation.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the left breast at 8 o'clock approximately 10 cm in the nipple there is a\n0.8 x 0.4 x 0.6 cm circumscribed, oval hypoechoic mass with posterior\nenhancement along the inferomedial implant capsule this previously measured\n0.6 x 0.6 x 0.3 cm is unchanged in size allowing for differences in\nmeasurement technique. As before, the mass is avascular but contains a\nminimal amount of hyperechoic content.", + "output": "Left breast mass is stable and likely benign. This likely represents either\nevolving fat necrosis or a fibroadenoma. Patient states that she will be\nhaving the implant removed. If this is excised along with surgery, no further\nimaging follow-up is required. However if not, ultrasound follow-up in ___ year\ncould be performed.\n\nRECOMMENDATION(S): If not surgically excise, ___ year follow-up could be\nperformed.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound of the entire inner left breast along the implant edge\nwhere the patient reports pain was performed. No fluid collection was seen. \nThe visualized aspects of the implant appear intact. Incidentally at 8:00\nposition 9 cm from the nipple there is a 5 x 3 x 3 mm oval parallel\ncircumscribed hypoechoic mass with internal vascularity.", + "output": "An incidental 5 mm circumscribed mass at 8:00 position approximately 9 cm from\nthe nipple in left breast. No fluid collection along the medial aspect of the\nimplant at the site of pain.\n\nRECOMMENDATION(S): Ultrasound-guided core needle biopsy of the indeterminate\nmass in the left breast is recommended. Clinical follow-up for pain/trauma.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. She was given information to schedule her biopsy appointment. The\nimpression and recommendation above was entered by Dr. ___ on\n___ at 09:02 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "In the reconstructed left breast at 8 o'clock, 9 cm from the nipple, again\nseen is a oval circumscribed hypoechoic mass measuring 5 x 3 x 3 cm with no\nsignificant posterior features. Internal vascularity is again demonstrated. \nThe mass was approximately 1.0 cm from the inferior edge of the left implant.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P. The procedure was supervised by ___.\n___, M.D..\n\nDescription:\nUsing ultrasound guidance, aseptic technique and local anesthesia, an attempt\nwas made to aspirate the mass. The mass did not completely aspirate. Then a\n16-gauge spring-loaded biopsy device was introduced within the mass and 5\ncores were obtained. Next, a percutaneous ribbon clip was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nStandard post procedure instructions were discussed with the patient.", + "output": "Technically successful US-guided core biopsy of the left breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted ultrasound 8 o'clock left breast 9 cm from the nipple at site of\nconcern as indicated by the patient demonstrates a subtle avascular oval\nhypoechoic region abutting the implant measuring 0.6 x 0.2 x 0.8 cm. This\nappears to correspond to the previously identified mass identified on\nultrasound from ___ and is smaller in size consistent with evolution\nof benign postoperative change.\n\nAgain noted is the previously biopsied benign lymph node 8 o'clock left breast\n9 cm from the nipple which is separate from site of concern on today's\nexamination.", + "output": "No sonographic Findings to account for patient's persistent/recurrent bruising\n8 o'clock left breast which appears to be deep to incision site related to\nimplant reconstruction and is separate from the core needle biopsy site from ___. Clinical follow-up is recommended.\n\nRECOMMENDATION(S): Clinical follow-up area of concern left breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe focal asymmetry in the upper outer breast appears pliable on the the MLO\nspot compression view and the true lateral view. It is somewhat persists on\nthe first spot compression view however is pliable on subsequent spot\ncompression views. This was further evaluated with ultrasound. There is no\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the upper outer\nbreast from ___ o'clock 3-8 cm from the nipple. No suspicious solid or cystic\nmass was identified.", + "output": "Focal asymmetry without a sonographic correlate is likely benign, and is felt\nto represent superimposed fibroglandular tissue. Left diagnostic mammogram in\n6 months is recommended for follow-up.\n\nRECOMMENDATION(S): Left diagnostic mammogram in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThe focal asymmetry in the upper outer breast appears pliable on the the MLO\nspot compression view and the true lateral view. It is somewhat persists on\nthe first spot compression view however is pliable on subsequent spot\ncompression views. This was further evaluated with ultrasound. There is no\narchitectural distortion or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the upper outer\nbreast from ___ o'clock 3-8 cm from the nipple. No suspicious solid or cystic\nmass was identified.", + "output": "Focal asymmetry without a sonographic correlate is likely benign, and is felt\nto represent superimposed fibroglandular tissue. Left diagnostic mammogram in\n6 months is recommended for follow-up.\n\nRECOMMENDATION(S): Left diagnostic mammogram in 6 months.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThere is moderate amount of atherosclerotic plaque at the bifurcation of the\nright carotid vasculature.\nThe peak systolic velocity in the right common carotid artery is 124 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 98, 94, and 149 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 37.7 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 163 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 106 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 130, 220, and 225 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 62.9 cm/sec.\nThe ICA/CCA ratio is 2.1.\nThe external carotid artery has peak systolic velocity of 150 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nOn the prior scan the distalmost ICAs were not fully evaluated and as such a\ndirect comparison cannot be performed. Note is made of tortuous distal ICAs\nbilaterally.", + "output": "1. Moderate right distal ICA stenosis (40-59%) however, note is made of a\ntortuous distal vessel. Moderate atherosclerotic plaque at the bifurcation of\nthe right carotid vasculature with no hemodynamically significant stenosis.\n\n2. Moderate atherosclerotic plaque in the left carotid vasculature with\nmoderate stenosis (40-59%) at the bifurcation and severe left distal ICA\nstenosis (70-79%), however note is made of a tortuous distal vessel." + }, + { + "input": "There is no evidence of a hernia. Re-demonstrated is an ovoid avascular focus\nin the anterior wall of the left lower abdomen which measures 3.9 x 2.6 x 0.7\ncm which is decreased in size as compared to ultrasound ___,\npreviously measuring 4.9 x 1.5 x 3.5 cm.", + "output": "No evidence of a hernia.\n\nInterval decrease in size of the seroma which measures up to 3.9 cm,\npreviously 4.9 cm on ___" + }, + { + "input": "Biceps tendon: The long head of the biceps tendon is well seen in the\nbicipital groove and normal.\n\nSupraspinatus: There is a 17 mm medial-lateral by 17 mm AP partial-thickness\nbursal sided tear, with areas of articular sided extension suggesting focal\nfull-thickness component, extending from the anterior to mid supraspinatus,\ninvolving the leading edge fibers. There is mild background tendinosis, with\nprobable dystrophic calcifications and moderate loss of muscle bulk.\n\nInfraspinatus: Thin in caliber, but no retracted tear.\n\nSubscapularis: There heterotopic calcifications within the proximal\ninsertional fibers of the subscapularis, either representing hydroxyapatite\ndeposition disease (calcific tendinosis), or dystrophic calcifications. No\nretracted tear.\n\nAcromioclavicular joint: Superior capsular hypertrophy, and early disc\ndegeneration.\n\nJoint effusion: There is communication of joint fluid to the\nsubacromial/subdeltoid bursa via the rotator cuff tear, with bursal thickening\nsuggesting bursitis.", + "output": "Small to moderate-sized partial-thickness bursal sided tear of the anterior to\nmid supraspinatus, with focal full-thickness component, on moderate background\ntendinosis, with mild loss of muscle bulk." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. The lesion for biopsy was identified in segment VI. A suitable\napproach for targeted liver biopsy was determined.\n\nLimited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected for both the\nparacentesis as well as the targeted biopsy and the skin was prepped and\ndraped in the usual sterile fashion. 1% lidocaine was instilled for local\nanesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.5 L of serosanguinous fluid were removed.\n\nDuring the drainage of this 1.5 L, under real-time ultrasound guidance, two,\n18-gauge core biopsy samples were obtained.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering 50 mcg fentanyl\nthroughout the total intra-service time of 22 minutes during which patient's\nhemodynamic parameters were continuously monitored by an independent trained\nradiology nurse.", + "output": "1. Uncomplicated 18-gauge targeted liver biopsy x 2, with specimen sent to\npathology.\n2. Technically successful ultrasound-guided therapeutic paracentesis." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is circumscribed oval mass in the lateral right breast at middle depth,\nas seen on recent screening mammogram. Otherwise, there is no suspicious\nmass, architectural distortion or grouped microcalcification.\n\nBREAST ULTRASOUND: At the 9 o'clock position of the right breast 4-5 cm from\nthe nipple, there is a normal appearing intramammary lymph node measuring 5 mm\nin diameter and corresponding to the mammographic mass.", + "output": "Intramammary lymph node in the right breast is benign.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 110 cm/s / 11.7 cm/s\nCCA Distal: 80.9 cm/s / 15.8 cm/s\nICA ___: 81.9 cm/s / 17.1 cm/s\nICA Mid: 87.4 cm/s / 17.7 cm/s\nICA Distal: 82.5 cm/s / 26.5 cm/s\nECA: 134 cm/s\nVertebral: 60.4 cm/s\n\nICA/CCA Ratio: 1.08\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 100 cm/s / 20.6 cm/s\nCCA Distal: 94.3 cm/s / 23.6 cm/s\nICA ___: 98.2 cm/s / 30.4 cm/s\nICA Mid: 90.4 cm/s / 26.5 cm/s\nICA Distal: 56.2 cm/s / 15.6 cm/s\nECA: 84.9 cm/s\nVertebral: 59.9 cm/s\n\nICA/CCA Ratio: 1.04\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "The aorta measures 2.3 cm in the proximal portion, 1.9 cm in mid portion and\n2.0 cm in the distal abdominal aorta. There is mild calcified atherosclerotic\nplaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.4 cm and the left common iliac artery\nmeasures 1.4 cm.\n\nThe right kidney measures 10.5 cm cm and the left kidney measures 10.9 cm cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "There is a heterogeneously hypoechoic well-circumscribed mass in the anterior\naspect of the distal right upper arm. The lesion measures 4.1 x 3.4 x 6.7 cm.\nThere is moderately increased vascularity and a small eccentric cystic\ncomponent measuring 0.4 cm.", + "output": "Technically successful ultrasound-guided biopsy of a mass in the right upper\narm." + }, + { + "input": "Bilateral targeted retroareolar ultrasound of the breast was performed. The\nleft retroareolar appears normal without dilated ducts. The right retroareolar\nregion appears normal without dilated ducts. Both retroareolar regions are\nwithout evidence of cysts or suspicious solid or cystic masses.", + "output": "No ultrasound abnormality in the retroareolar regions.\n\nRECOMMENDATION: Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe area of prior concern is less prominent on the current views. Due to the\ntissue density, the patient was taken to ultrasound for further evaluation.\n\nBREAST ULTRASOUND: Targeted ultrasound of the medial left breast was\nperformed and is unremarkable. Targeted ultrasound of the lateral left breast\nat 2 o'clock 6 cm from the nipple demonstrates an 8 x 3 x 6 mm cluster of\ncysts with internal septations. There is no dominant vascularity and through\ntransmission the same.", + "output": "Cluster of cysts in the left breast.\n\nRECOMMENDATION: Six-month ultrasound followup is recommended at this time.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe area of prior concern is less prominent on the current views. Due to the\ntissue density, the patient was taken to ultrasound for further evaluation.\n\nBREAST ULTRASOUND: Targeted ultrasound of the medial left breast was\nperformed and is unremarkable. Targeted ultrasound of the lateral left breast\nat 2 o'clock 6 cm from the nipple demonstrates an 8 x 3 x 6 mm cluster of\ncysts with internal septations. There is no dominant vascularity and through\ntransmission the same.", + "output": "Cluster of cysts in the left breast.\n\nRECOMMENDATION: Six-month ultrasound followup is recommended at this time.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted sonographic assessment was performed in the area of previously\ndocumented ultrasound finding. At 2 o'clock 6 cm from the nipple, there is a\ncluster of small cysts with internal septations measuring 0.7 x 0.5 x 0.4 cm\n(previously 0.8 x 0.6 x 0.3 cm), which is little changed from the prior\nultrasound. There is increased through transmission and no dominant\nvascularity.", + "output": "Probably benign cluster of cysts in the left breast, likely apocrine\nmetaplasia.\n\nRECOMMENDATION(S): Continued followup with left breast ultrasound in 6 months\nis reasonable, at which time the patient is due for annual screening\nmammography in the left breast asymmetry can be re-evaluated for expected\nstability.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications. An apparent asymmetry in the inner left breast at\nposterior depth on the initial craniocaudal view is pliable on additional\nviews, consistent with normal superimposed breast tissue.\n\nBREAST ULTRASOUND: Targeted ultrasound at 2 o'clock position 6 cm from the\nnipple in the area of previously evaluated cluster of cysts was performed. \nPreviously seen cluster cysts has almost entirely resolved with a small 1 mm\ncyst remaining in the area.\n\nIncidentally, at 3 o'clock position 3 cm from nipple there is a 7 x 3 x 5\nhypoechoic mass with no internal vascularity or posterior features, likely\nrepresenting a cluster of cysts. Ultrasound of the inner left breast in the\narea of initially seen asymmetry was performed. At 8:30 o'clock position 5 cm\nfrom the nipple there is a 8 x 4 x 6 mm hypoechoic area, likely representing\nnormal fibroglandular tissue, however short-term interval followup to document\nstability with left breast ultrasound in 6 months is recommended.", + "output": "1. Previously seen cluster of cysts at 2 o'clock position in the left breast\nhas resolved, consistent with benign finding.\n\n2. 2 probably benign findings are seen on ultrasound incidentally in the left\nbreast: a 7 mm probably benign hypoechoic mass, likely representing a cluster\nof cysts at 3 o'clock position 3 cm from the nipple and an 8 mm hypoechoic\narea at 8:30 o'clock position 5 cm from nipple, thought to likely represent an\nisland of normal glandular tissue.\n\nRECOMMENDATION(S): Six-month follow-up ultrasound of the left breast to\ndocument stability of the above probably benign findings.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Targeted ultrasound at 830 o'clock 5 cm from the nipple demonstrates an\nill-defined hypoechoic area measuring 0.7 x 0.3 x 0.6 cm previously 0.8 x 0.4\nx 0.6 cm on ___. This is stable in appearance and may represent a\npatch of fibroglandular tissue or a complicated cyst.\nTargeted ultrasound at 3 o'clock 3 cm from the nipple demonstrates a 0.7 x 0.3\nx 0.6 cm hypoechoic mass previously measuring 0.7 x 0.3 x 0.5 cm, unchanged\nappearance and likely representing cluster of microcysts.", + "output": "Six month stability of a probable cluster of cysts at 3 o'clock and a\nhypoechoic area at 8:30 o'clock possibly representing a patchy fibroglandular\ntissue. Continued follow-up in six months with ultrasound is recommended to\ndocument stability, at which time the patient is due for her annual mammogram.\n\nRECOMMENDATION(S): Left breast ultrasound in six months, at which time the\npatient is due for her annual mammogram.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nNo evidence of suspicious mass, unexplained architectural distortion, or\ngrouped microcalcifications. No significant change.\n\nBREAST ULTRASOUND: Targeted ultrasound in the previously areas of concern in\nthe left breast, a probable cluster of microcysts at 3 o'clock and a\nhypoechoic area at 8:30 o'clock possibly representing patchy fibroglandular\ntissue, was performed. Again seen at the 3 o'clock position, 3 cm from the\nnipple, there is a 5 x 3 x 5 mm (previously 7 x 3 x 6 mm) hypoechoic mass with\nno internal vascularity or posterior features, likely representing a cluster\nof cysts. At the 8:30 o'clock position, 5 cm from the nipple, again seen is a\n7 x 3 x 5 mm (previously 7 x 3 x 6 mm) hypoechoic area, likely representing\nnormal fibroglandular tissue versus complicated cyst. Overall, minimal\nchanges noted in both of these areas, allowing for differences in measuring\ntechnique.", + "output": "___ year stability of 2 probably benign masses on ultrasound of the left breast.\nRecommend ___ year follow-up with diagnostic mammography and left breast\nultrasound.\n\nRECOMMENDATION(S): Diagnostic mammography and left breast ultrasound in ___\nyear for probably benign left ultrasound findings.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nStable benign calcifications right breast. There is no dominant mass,\narchitectural distortion or suspicious grouped microcalcifications. No\nsignificant change from prior study.\n\nBREAST ULTRASOUND: Stable cluster of microcysts 3:00 position left breast 3\ncm from the nipple measuring 5 x 5 x 5 mm. Stable to slight decrease in size\nof previously identified hypoechoic area 8 to 9:00 position left breast 5 cm\nfrom the nipple currently measuring 4 x 2 x 4 mm.", + "output": "1. No specific mammographic evidence of malignancy within either breast.\n2. Two year stability of two probably benign masses in left breast as\ndescribed above 1 of which is felt to represent a cluster of microcysts. No\nfurther imaging follow-up is required.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant under real-time ultrasound guidance and 3 L of clear tan fluid\nwas removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided therapeutic paracentesis with removal\nof 3 L ascitic fluid." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5 L of amber-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5 L of fluid were removed." + }, + { + "input": "Right internal carotid artery: Vessel caliber smooth and regular. There is\nopacification the anterior middle cerebral arteries no distal territories. \nThere is a 4 x 4 para ophthalmic artery aneurysm. There is a fetal PCOM. \nThere is no evidence of additional aneurysm or AVM.\n\nRight internal carotid artery after pipeline deployment: There is\nopacification the anterior middle cerebral arteries. There is no evidence of\nvessel dropout. There is no evidence of in stent stenosis. There is still\nfilling of the aneurysm. The ophthalmic artery continues to fill. There is\nappropriate placement of the pipeline device across the neck of the aneurysm. \nThree-dimensional rotational image confirms placement of the pipeline across\nthe neck of the aneurysm.\n\n Right common femoral artery: Arteriotomy is above the bifurcation. There is\ngood distal runoff. There is no evidence of dissection. Vessel caliber\nappropriate for closure device.", + "output": "Uncomplicated pipeline embolization of right para ophthalmic artery aneurysm\n\nRECOMMENDATION(S):\n1. Likely angiogram in ___ year" + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a moderate\namount ofascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.9 L of clear, straw-coloredfluid was removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ attending radiologist, was present throughout the critical\nportions of the procedure.", + "output": "Uneventful diagnostic and therapeutic paracentesis yielding 1.9 L of clear,\nstraw-colored ascitic fluid." + }, + { + "input": "The liver is normal in echotexture, without focal lesions or intrahepatic\nbiliary ductal dilatation. Main portal vein is patent with hepatopetal flow.\nThe CBD measures 4 mm. The gallbladder has been removed. Imaged portion of\nthe pancreas appears within normal limits, without masses or pancreatic ductal\ndilation, with portions of the pancreatic tail obscured by overlying bowel\ngas. The spleen measures 12 cm, and is normal in echogenicity.\n\nThe right kidney measures 8.6 cm. There is a 1 cm nonobstructive stone in the\ninterpolar region of the right kidney. There also 3 sub cm right cysts without\nconcerning features. Otherwise there is no hydronephrosis or solid renal\nmasses. There is no ascites.", + "output": "1. Normal appearance of the liver. No biliary dilatation.\n\n2. Nonobstructive 1 cm stone in the interpolar region of the right kidney.\n\n3. Three sub cm simple cysts in the right kidney." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nA 1.2 cm spiculated mass is seen in the right upper, central breast mid depth,\nwhich corresponds to the mass seen on the recent CT scan. This also\ncorresponds to a solid irregular mass in the 12 o'clock on same day\nultrasound. The left breast is unremarkable without any dominant mass,\nsuspicious microcalcifications or focal architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right upper central quadrant\nand right axilla was performed. In the 12 o'clock, 7 cm from the nipple there\nis a solid hypoechoic mass with angular margins and posterior shadowing and\nperipheral echogenic halo. This measures 1.0 x 0.5 x 0.6 cm and demonstrates\nsome internal vascularity. This corresponds to the spiculated mass seen on\nsame day mammogram. Ultrasound of the right axilla demonstrates lymph nodes\nwith cortical thickness of 3.5 mm.", + "output": "Solid mass in the 12 o'clock right breast with features that are highly\nsuspicious for malignancy. An ultrasound-guided core biopsy is recommended.\nFindings were communicated to Dr. ___ by Dr. ___ via email\non ___ at 2:50pm.\n\nRECOMMENDATION(S): Ultrasound guided core biopsy of solid mass in the right\nbreast as described above is recommended and was performed falling the\ndiagnostic evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy who agrees with the plan.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "In the right breast at 12 o'clock 7 cm from the nipple there is a 0.6 x 0.5 x\n1.0 cm hypoechoic mass with angular margins and posterior shadowing which was\ntargeted for ultrasound-guided biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD ___. The procedure was supervised by ___.\n___ (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm clip placement in the\nslightly medial to the biopsied mass with post biopsy changes.\n\nUpon review of the post procedure mammogram there are grouped calcifications\nin the right upper outer breast for which additional imaging and a biopsy is\nrecommended.", + "output": "1. Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n2. Grouped calcifications in the upper-outer right breast for which biopsy is\nrecommended. The patient will require magnification views at the time of the\nscheduled stereotactic core biopsy.\n\nThese findings and recommendation for the stereotactic core biopsy were\ndiscussed with Dr. ___ by Dr. ___ at 16:45 on ___.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "In the right breast at 12 o'clock 7 cm from the nipple there is a 0.6 x 0.5 x\n1.0 cm hypoechoic mass with angular margins and posterior shadowing which was\ntargeted for ultrasound-guided biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD ___. The procedure was supervised by ___.\n___ (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm clip placement in the\nslightly medial to the biopsied mass with post biopsy changes.\n\nUpon review of the post procedure mammogram there are grouped calcifications\nin the right upper outer breast for which additional imaging and a biopsy is\nrecommended.", + "output": "1. Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n2. Grouped calcifications in the upper-outer right breast for which biopsy is\nrecommended. The patient will require magnification views at the time of the\nscheduled stereotactic core biopsy.\n\nThese findings and recommendation for the stereotactic core biopsy were\ndiscussed with Dr. ___ by Dr. ___ at 16:45 on ___.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "The right axilla and upper central chest were evaluated with ultrasound. No\nabnormalities are identified. No abnormal axillary lymph nodes are seen.", + "output": "No suspicious findings are identified in the right axilla or upper chest.\n\nRECOMMENDATION(S): Clinical correlation is recommended. If there is\ncontinued clinical concern for axillary adenopathy, more in-depth evaluation\nis recommended with contrast enhanced breast MRI.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Findings were communicated to Dr. ___ at the time of interpretation.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Targeted imaging of the left breast in the inferior medial quadrant (7\no'clock) was performed. No fluid collections or focal lesions identified.", + "output": "No evidence of fluid collections in the inferior medial quadrant of the left\nbreast.\n\nRECOMMENDATION(S): Follow-up at the ___ breast care center is recommended\nfor further detailed imaging evaluation of the left breast.\n\nNo evidence of fluid collections in the inferior medial \nquadrant of the left breast. Follow-up at the ___ breast care center is\nrecommended for further detailed imaging evaluation of the left breast." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. The previously seen left breast asymmetry\ndoes not persist on the additional views and therefore is consistent with\nsuperimposed breast parenchyma. However, due to the density of the tissue,\nultrasound was undertaken to exclude an underlying lesion.\n\nTargeted ultrasound was performed in the left breast from ___ o'clock 1-8 cm\nfrom the nipple corresponding to the area of concern on mammography. No\nsuspicious solid or cystic masses are seen.", + "output": "Left breast asymmetry on recent mammogram ___ corresponding to\nsuperimposed breast tissue. The patient may resume routine screening.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. The previously seen left breast asymmetry\ndoes not persist on the additional views and therefore is consistent with\nsuperimposed breast parenchyma. However, due to the density of the tissue,\nultrasound was undertaken to exclude an underlying lesion.\n\nTargeted ultrasound was performed in the left breast from ___ o'clock 1-8 cm\nfrom the nipple corresponding to the area of concern on mammography. No\nsuspicious solid or cystic masses are seen.", + "output": "Left breast asymmetry on recent mammogram ___ corresponding to\nsuperimposed breast tissue. The patient may resume routine screening.\n\nRECOMMENDATION(S): Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited ultrasound of the abdomen and pelvis was obtained to assess for\nascites.\n\nThere is trace pelvic ascites. No abdominal ascites is detected.", + "output": "Trace pelvic ascites, increased as compared to abdominal ultrasound ___." + }, + { + "input": "Right breast mass 10 o'clock 8 cm from the nipple measuring 1.6 x 1.1 x 0.8 cm\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___. \n___, M.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 6 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending The patient expects to hear the pathology results from the\nreferring provider ___ ___ business days. Standard post care instructions were\nprovided to the patient.\n\n As the Attending radiologist, I personally supervised the Nurse Practitioner\nduring the key components of the above procedure and agree with their findings\nand dictation." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with scattered areas of\nmoderately dense fibroglandular tissue which somewhat lowers the sensitivity\nof mammography. There is a persistent circumscribed mass in the upper outer\nright breast with a contiguous tiny adjacent mass. A benign appearing\nintramammary node is seen in the upper outer posterior right breast as well.\n\nUltrasound of the right breast at 10 o'clock 8 cm from the nipple identifies a\n1.7 x 0.8 x 1.6 cm solid heterogeneous mass with a contiguous 0.2 x 0.2 x 0.2\ncm component. Although this may represent a fibroadenoma, ultrasound-guided\ncore biopsy should be considered to obtain a definitive diagnosis given the\ninternal heterogeneity. At 10 o'clock 12 cm from the nipple is identified a\nbenign appearing low axillary node measuring 0.8 x 0.5 x 0.4 cm.", + "output": "Solid heterogeneous mass in the right breast at 10 o'clock likely\ncorresponding to the findings on mammography and for which ultrasound-guided\ncore biopsy is recommended to obtain a definitive diagnosis.\n\nRECOMMENDATION: Right breast ultrasound-guided core biopsy\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\nResults were also communicated by phone to Dr. ___ on ___ at 16:44 after completion of the diagnostic evaluation.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with scattered areas of\nmoderately dense fibroglandular tissue which somewhat lowers the sensitivity\nof mammography. There is a persistent circumscribed mass in the upper outer\nright breast with a contiguous tiny adjacent mass. A benign appearing\nintramammary node is seen in the upper outer posterior right breast as well.\n\nUltrasound of the right breast at 10 o'clock 8 cm from the nipple identifies a\n1.7 x 0.8 x 1.6 cm solid heterogeneous mass with a contiguous 0.2 x 0.2 x 0.2\ncm component. Although this may represent a fibroadenoma, ultrasound-guided\ncore biopsy should be considered to obtain a definitive diagnosis given the\ninternal heterogeneity. At 10 o'clock 12 cm from the nipple is identified a\nbenign appearing low axillary node measuring 0.8 x 0.5 x 0.4 cm.", + "output": "Solid heterogeneous mass in the right breast at 10 o'clock likely\ncorresponding to the findings on mammography and for which ultrasound-guided\ncore biopsy is recommended to obtain a definitive diagnosis.\n\nRECOMMENDATION: Right breast ultrasound-guided core biopsy\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\nResults were also communicated by phone to Dr. ___ on ___ at 16:44 after completion of the diagnostic evaluation.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Right breast mass 10 o'clock 8 cm from the nipple measuring 1.6 x 1.1 x 0.8 cm\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, N.P.. The procedure was supervised by ___. \n___, M.D.(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 6 cores were obtained. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the breast lesion. Pathology\nis pending The patient expects to hear the pathology results from the\nreferring provider ___ ___ business days. Standard post care instructions were\nprovided to the patient.\n\n As the Attending radiologist, I personally supervised the Nurse Practitioner\nduring the key components of the above procedure and agree with their findings\nand dictation." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe asymmetry in the right upper outer mid breast is pliable on spot\ncompression views and appears consistent with summation of shadows. Given\ndense breast ultrasound evaluation was also performed.\n\nBREAST ULTRASOUND: Targeted ultrasound the right upper outer breast was\nperformed and no discrete solid or cystic mass seen. Dense tissue noted in\nthe right breast at 10 o'clock.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "SPLEEN: Normal echogenicity.\n Spleen length: 14.2 cm", + "output": "Mild splenomegaly measuring up to 14 cm slightly increased in size compared to\n___ where it measured up to 12 cm." + }, + { + "input": "RIGHT:\nThere is minimal atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 97.3 cm/s / 24 cm/s\nCCA Distal: 90.3 cm/s / 22.9 cm/s\nICA ___: 64.8 cm/s / 18.9 cm/s\nICA Mid: 62.5 cm/s / 29.5 cm/s\nICA Distal: 108 cm/s / 37.7 cm/s\nECA: 78.6 cm/s\nVertebral: 82.7 cm/s\n\nICA/CCA Ratio: 1.2\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is minimal atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 68.6 cm/s / 9.97 cm/s\nCCA Distal: 63.3 cm/s / 12.9 cm/s\nICA ___: 42.4 cm/s / 11 cm/s\nICA Mid: 48.7 cm/s / 18.1 cm/s\nICA Distal: 49.9 cm/s / 20.8 cm/s\nECA: 70.3 cm/s\nVertebral: 107 cm/s\n\nICA/CCA Ratio: .77\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA no stenosis with minimal atherosclerotic plaque.\nLeft ICA no stenosis with minimal atherosclerotic plaque.\n\nWhen compared to report of ___, the findings are similar.\n\nRECOMMENDATION(S): The reported stenoses seen on prior CTA are more distal\nthan can be visualized by ultrasound thus recommend alternative image modality\nif further assessment is warranted." + }, + { + "input": "About 4 cm ovoid lymph node in the right axilla with central hypo echogenicity\nsuggesting necrosis.", + "output": "Ultrasound-guided biopsy of the right axillar lymph node." + }, + { + "input": "Evaluation is limited by body habitus. Within this limitation, the aorta\nmeasures 1.5 cm in the proximal portion, 1.7 cm in mid portion and 1.9 cm in\nthe distal abdominal aorta. There is mild calcified atherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.1 cm and the left common iliac artery\nmeasures 1.0 cm.\n\nThe right kidney measures 12.3 cm and the left kidney measures 14.0 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 61.3 cm/s / 12.2 cm/s\nCCA Distal: 67.2 cm/s / 11.4 cm/s\nICA ___: 72.1 cm/s / 11.1 cm/s\nICA Mid: 61.3 cm/s / 14.9 cm/s\nICA Distal: 79.7 cm/s / 18.4 cm/s\nECA: 93.4 cm/s\nVertebral: 40.1 cm/s\n\nICA/CCA Ratio: 1.19\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 96.2 cm/s / 17 cm/s\nCCA Distal: 68 cm/s / 12.3 cm/s\nICA ___: 53 cm/s / 9.43 cm/s\nICA Mid: 70.4 cm/s / 15.2 cm/s\nICA Distal: 57 cm/s / 14.9 cm/s\nECA: 74.8 cm/s\nVertebral: 31.4 cm/s\n\nICA/CCA Ratio: 1.04\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "At site of patient pain no identifiable abnormality seen. No focal fluid\ncollection or ___ cyst. No lymph node. No mass. A patent superficial\nvessel is identified without evidence of thrombophlebitis. No subcutaneous\nedema.", + "output": "Normal ultrasound of posterior right knee at site of patient's symptoms." + }, + { + "input": "Grayscale, color, and spectral doppler imaging was obtained of the right and\nleft common femoral, femoral, and popliteal veins. Examination is limited by\nreduced acoustic penetration due to body habitus. Normal flow,\ncompressibility, augmentation, and waveforms are demonstrated (compression\nviews were not obtained of the distal superficial femoral or popliteal veins\nbilaterally due to limited visualization on grayscale images). No intraluminal\nthrombus is identified. Color flow is demonstrated in limited views of the\nposterior tibial and peroneal veins. There is normal respiratory variation in\nboth common femoral veins. A ___ cyst is seen on the left measuring 4.6 x\n1.1 x 2.0 cm.", + "output": "Limited examination due to reduced acoustic penetration related to body\nhabitus. No evidence of deep vein thrombosis in right or left lower\nextremity, with limited views of distal superficial femoral, popliteal, and\ncalf veins." + }, + { + "input": "Preprocedure ultrasound re-demonstrated the extensive superficial fluid\ncollection that extends throughout the lateral right thigh adjacent to the\nsuture line. More superiorly, this collection is complex with internal linear\nechogenicities, appearing more simple inferiorly. The inferior aspect of the\ncollection was targeted for aspiration.", + "output": "Successful US-guided aspiration of the lateral right thigh collection,\nyielding 2 cc of hemorrhagic fluid. The sample was sent for microbiology\nevaluation." + }, + { + "input": "There are hypoechoic postoperative changes/granulation tissue adjacent to the\nanterior capsule, and overlying rectus femoris tendon, with heterotopic\ncalcifications. There is a small amount of fluid within the anterior joint\nspace, overlying the antibiotic impregnated spacer of the femoral prosthesis. \nNo prominent synovial thickening, hyperemia, or debris. There is also\nsagittal hypoechoic area, interposed between the bone metal interface of the\nfemoral prosthesis of the anterior cortex, that could represent fluid, or\ngranulation tissue.", + "output": "1. Technically successful and uncomplicated ultrasound-guided aspiration of\nright hip.\n2. Small joint effusion, possibly surrounding the proximal femoral prosthesis\nat the bone metal interface." + }, + { + "input": "The aorta measures 2.4 x 2.3 cm in the proximal portion, 2.1 x 2.7 cm in mid\nportion and 2.5 x 2.5 cm in the distal abdominal aorta. There is mild\ncalcified atherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.1 cm and the left common iliac artery\nmeasures 1.3 cm.\n\nThe right kidney measures 12.2 cm and the left kidney measures 13.4 cm.\nLimited views of the kidneys are unremarkable without hydronephrosis. Several\nrenal cysts are identified in left kidney.", + "output": "No evidence of abdominal aortic aneurysm." + }, + { + "input": "At the 9 o'clock position subareolar right breast there is a round\ncircumscribed possibly intraductal mass measuring 0.7 x 0.6 x 0.3 cm which\ndemonstrates peripheral vascularity. Multiple cysts are seen within the right\nbreast corresponding to additional masses on mammogram with the largest at the\n10 o'clock position 6 cm from the nipple.", + "output": "0.7 cm mass 9:00 position subareolar right breast, possibly intraductal in\nlocation corresponding to Finding on mammogram.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy right breast mass is recommended.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who desires to speak with her primary care physician prior to\nscheduling biopsy. The findings were also communicated to ___, M.D. by\n___, M.D. via email on ___ at 2:18 pm.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Targeted ultrasound of the right breast at 9 o'clock, 0 cm from the nipple\nagain demonstrates an oval, hypoechoic, vascular mass, which was targeted for\nbiopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, MD the procedure was supervised by ___, M.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 1\ncore was obtained using a 14-gauge Sertera no throw biopsy device. Then, 4\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:Deferred due to visualization of the clip on\nultrasound.", + "output": "Technically successful US-guided core biopsy of the right breast mass.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of 9\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThe breast tissue is heterogeneously dense which may obscure the detection for\nsmall masses. Post treatment changes are noted in the right breast. A 1.8 cm\nfat containing area is identified within the lumpectomy bed that has the\nappearance of fat necrosis. Additional benign calcifications are noted\nincluding vascular calcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe area of clinical concern beneath the right surgical scar at 10 o'clock 3\ncm from the nipple there is a heterogeneous area that measures 1.9 x 1.8 x 1.5\ncm. There is no internal vascularity. This discrete area may correlate with\nthe area of developing fat necrosis seen on mammography. No additional\nsuspicious areas are identified", + "output": "The area of clinical concern may correlate with an area fat necrosis seen on\nultrasound and mammography. A six-month followup left breast mammogram and\nultrasound is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThe breast tissue is heterogeneously dense which may obscure the detection for\nsmall masses. Post treatment changes are noted in the right breast. A 1.8 cm\nfat containing area is identified within the lumpectomy bed that has the\nappearance of fat necrosis. Additional benign calcifications are noted\nincluding vascular calcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe area of clinical concern beneath the right surgical scar at 10 o'clock 3\ncm from the nipple there is a heterogeneous area that measures 1.9 x 1.8 x 1.5\ncm. There is no internal vascularity. This discrete area may correlate with\nthe area of developing fat necrosis seen on mammography. No additional\nsuspicious areas are identified", + "output": "The area of clinical concern may correlate with an area fat necrosis seen on\nultrasound and mammography. A six-month followup left breast mammogram and\nultrasound is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC bilateral MAMMOGRAM WITH CAD:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast post treatment changes are stable. No discrete abnormality is\nidentified to correlate with the area that was palpable in ___. \nBenign calcifications are noted bilaterally. The previously noted\narchitectural distortion in the left breast in ___, best appreciated\non the MLO projection, is not visualized on the current examination. This\narea was further evaluated with ultrasound, as well as the right breast\nfinding. Left breast asymmetries are stable. No new mass, or suspicious\nmicrocalcifications is noted in either breast.\n\nRIGHT BREAST ULTRASOUND: At 10 o'clock 1-5 cm from the nipple there is re-\ndemonstration of a 1.9 x 1.8 x 1.2 cm heterogeneous area immediately below the\nsurgical scar that has a more heterogeneous and hypoechoic appearance on the\nprior exam. This likely relates to oval filling postsurgical changes.\nContinued followup is recommended.\n\nLEFT BREAST ULTRASOUND: The entire left upper breast was scanned to evaluate\nfor an on underlying abnormality that possibly was contributing to the area of\narchitectural distortion, however, no abnormality is identified. A surgical\nscar is noted in the superior left breast and presumably the architectural\ndistortion seen on imaging correlates with this finding. No suspicious\nabnormality was noted.", + "output": "Probable postsurgical changes in the right breast. Continued followup in 6\nmonths is recommended with ultrasound only.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "DIGITAL DIAGNOSTIC bilateral MAMMOGRAM WITH CAD:\nTissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\n\nRight breast post treatment changes are stable. No discrete abnormality is\nidentified to correlate with the area that was palpable in ___. \nBenign calcifications are noted bilaterally. The previously noted\narchitectural distortion in the left breast in ___, best appreciated\non the MLO projection, is not visualized on the current examination. This\narea was further evaluated with ultrasound, as well as the right breast\nfinding. Left breast asymmetries are stable. No new mass, or suspicious\nmicrocalcifications is noted in either breast.\n\nRIGHT BREAST ULTRASOUND: At 10 o'clock 1-5 cm from the nipple there is re-\ndemonstration of a 1.9 x 1.8 x 1.2 cm heterogeneous area immediately below the\nsurgical scar that has a more heterogeneous and hypoechoic appearance on the\nprior exam. This likely relates to oval filling postsurgical changes.\nContinued followup is recommended.\n\nLEFT BREAST ULTRASOUND: The entire left upper breast was scanned to evaluate\nfor an on underlying abnormality that possibly was contributing to the area of\narchitectural distortion, however, no abnormality is identified. A surgical\nscar is noted in the superior left breast and presumably the architectural\ndistortion seen on imaging correlates with this finding. No suspicious\nabnormality was noted.", + "output": "Probable postsurgical changes in the right breast. Continued followup in 6\nmonths is recommended with ultrasound only.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "In the right breast, at 10 o'clock, 3-5 cm from the nipple, there is a\nheterogeneous area with no internal vascularity, measuring 1.6 x 1.6 x 1.5 cm.\nThis appears to be associated with the surgical scar, and is not significantly\nchanged from the prior ultrasound of ___.", + "output": "Heterogeneous area adjacent to the surgical scar likely reflects post surgical\nchanges.\n\nRECOMMENDATION(S): Six-month followup ultrasound at the time of bilateral\nmammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nThere is stable right breast skin thickening and focal architectural\ndistortion in the right upper outer quadrant along with surgical clips at the\nsite of lumpectomy. A single surgical clip in the left upper central breast\nat the site of prior benign excision is unchanged. There is no dominant mass,\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper-outer was scanned. In the 10 o'clock, 3-5 cm from the nipple again\nidentified is a heterogeneous partly solid partly cystic area without internal\nvascularity or posterior features. This measures 1.4 x 0.8 x 1.5 cm and is\nsonographically stable in appearance since ___.", + "output": "18 month stability of heterogeneous right breast area likely representing\npostsurgical changes.\n\nRECOMMENDATION: Followup in ___ year with a right breast ultrasound is\nrecommended to be performed at the time of bilateral annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: C - The breasts are heterogeneously dense, which may obscure\nsmall masses\nThere is stable right breast skin thickening and focal architectural\ndistortion in the right upper outer quadrant along with surgical clips at the\nsite of lumpectomy. A single surgical clip in the left upper central breast\nat the site of prior benign excision is unchanged. There is no dominant mass,\nunexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND:\n\nThe upper-outer was scanned. In the 10 o'clock, 3-5 cm from the nipple again\nidentified is a heterogeneous partly solid partly cystic area without internal\nvascularity or posterior features. This measures 1.4 x 0.8 x 1.5 cm and is\nsonographically stable in appearance since ___.", + "output": "18 month stability of heterogeneous right breast area likely representing\npostsurgical changes.\n\nRECOMMENDATION: Followup in ___ year with a right breast ultrasound is\nrecommended to be performed at the time of bilateral annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There are stable post treatment changes in\nthe right breast with evidence of fat necrosis within the biopsy bed and\npersistent diffuse in areolar skin thickening. An asymmetry in the inferior\ncysts right breast on the initial MLO did not persist on additional imaging\nand corresponds to superimposed breast tissue. An asymmetry in the inferior\ncentral left breast on the initial CC view also did not persist on the\nadditional imaging and now has a similar appearance to that seen in ___. \nBilateral vascular calcifications are again seen.\n\nUltrasound of the right breast at 10 o'clock 3-5 cm from the nipple in the\narea of concern on prior imaging demonstrates a stable 1.6 x 1.1 x 1.5 cm\nheterogeneous mass which when correlated with mammography has an imaging\nappearance at consistent with fat necrosis. Given stability, this is\nconsistent with a benign finding and no further imaging followup is necessary\nat this time.", + "output": "Three-year stability of heterogeneous mass at 10 o'clock in the right breast,\nconsistent with a benign finding. Stable right post treatment changes. No\nspecific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Annual diagnostic mammography based on age and clinical\nco-morbidities.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She will follow up with her provider determine whether\nshe should continue to undergo annual mammography.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There are stable post treatment changes in\nthe right breast with evidence of fat necrosis within the biopsy bed and\npersistent diffuse in areolar skin thickening. An asymmetry in the inferior\ncysts right breast on the initial MLO did not persist on additional imaging\nand corresponds to superimposed breast tissue. An asymmetry in the inferior\ncentral left breast on the initial CC view also did not persist on the\nadditional imaging and now has a similar appearance to that seen in ___. \nBilateral vascular calcifications are again seen.\n\nUltrasound of the right breast at 10 o'clock 3-5 cm from the nipple in the\narea of concern on prior imaging demonstrates a stable 1.6 x 1.1 x 1.5 cm\nheterogeneous mass which when correlated with mammography has an imaging\nappearance at consistent with fat necrosis. Given stability, this is\nconsistent with a benign finding and no further imaging followup is necessary\nat this time.", + "output": "Three-year stability of heterogeneous mass at 10 o'clock in the right breast,\nconsistent with a benign finding. Stable right post treatment changes. No\nspecific mammographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Annual diagnostic mammography based on age and clinical\nco-morbidities.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She will follow up with her provider determine whether\nshe should continue to undergo annual mammography.\n\nBI-RADS: 2 Benign." + }, + { + "input": "The patient was not prepped for abdominal ultrasound. Two representative\nimages of the gall bladder demonstrate the gallbladder to be contracted. \nThere are no obvious stones however, this is not a complete examination.", + "output": "Unable to perform full abdominal ultrasound due to contraction of the\ngallbladder due to nonfasting state. There should be no charge to the patient\nas this has been rescheduled." + }, + { + "input": "9 cm right hepatic lobe hypoechoic collection with thin internal septations\nand echogenic foci. This was targeted for ultrasound-guided drainage catheter\nplacement. The collection decompressed to a 3.8 cm after drainage. 240 cc of\nserosanguineous fluid were aspirated. The fluid appeared somewhat turbid\ntowards the end of the drainage.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.5 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 20 mL of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 20 mL of fluid were removed.\n3. The patient was transferred to the floor in a hemodynamically stable\ncondition." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 7.0 L of green-yellow clear fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7.0 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.4 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Ultrasound guided therapeutic paracentesis.5.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.8 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 4.15 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.15 L of fluid were removed." + }, + { + "input": "The uterus measures 12.3 x 7.9 x 6.5 cm. Multiple uterine fibroids are re-\ndemonstrated. 2 of these had a significant submucosal component as seen at\nrecent CT abdomen pelvis. There has been interval removal of the IUD. No large\nhematoma is seen within the endometrial cavity. The endometrial stripe is\ndistorted and difficult to accurately assess.\n\nMildly complex tubular structure in the left adnexum again noted consistent\nwith hydrosalpinx. Given internal complexity of the fluid, superinfection\ndifficult to exclude. Consider MRI for further assessment.", + "output": "1. Submucosal fibroids redemonstrated with resultant distortion of the\nendometrial stripe.\n2. No large hematoma within the endometrial cavity.\n3. Left adnexal hydrosalpinx (again noted) appears mildly complex - cannot\nexclude infection.\n4. Interval removal of IUD." + }, + { + "input": "Tissue density: A - The breast tissue is almost entirely fatty.\nThere is no significant gynecomastia. There are no suspicious findings in the\nright breast.\n\nIn the left upper outer quadrant peripherally, there is a circumscribed,\nsmoothly lobulated mass with a fatty center corresponding to the palpable\nfinding indicated by a skin marker. There are no associated\nmicrocalcifications. Mammographically this is consistent with a lymph node.\n\nBREAST ULTRASOUND: Focused ultrasound of the palpable finding indicated by\nthe patient to be in the left breast at 1 o'clock 7 cm from the nipple shows\nthat it corresponds to a sonographically normal lymph node with a smooth\ncortex and echogenic center, measuring 1.3 x 0.6 by 1.2 cm. The cortex\nmeasures 2 mm maximally.", + "output": "The palpable finding indicated by the patient in the left upper outer quadrant\ncorresponds to a mammographically and sonographically normal lymph node\nmeasuring 1.3 cm maximally. There are no suspicious mammographic findings in\neither breast. There is no significant gynecomastia.\n\nRECOMMENDATION(S): As discussed with the patient, clinical follow-up of the\npalpable lymph node is recommended and the patient will follow-up with his\nreferring clinician.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the upper-outer left breast at 3 o'clock position 12 cm from nipple\nunderneath the surgical scar there is an approximately 9 x 6 x 2 cm\npredominantly simple fluid collection with a few septations.", + "output": "There is a 9 cm postsurgical fluid collection in the upper-outer left breast.\n\nRECOMMENDATION(S): Clinical followup is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Additionally, ___, N.P. was notified via email.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the left breast was performed from ___ o'clock, in the\nareas of clinical concern, as indicated by the patient. There is diffusely\nedematous breast tissue without a large fluid collection identified. There is\navascular echogenic material in the upper inner breast spanning from ___\no'clock., with the imaging appearance favoring hematoma. Due to the size of\nthe collection, measurements could not be obtained.", + "output": "Diffusely edematous left breast tissue, with echogenic material in the upper\ninner breast from ___ o'clock most consistent with hematoma.\n\nRECOMMENDATION(S): Continued follow-up is recommended as clinically\nindicated.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. These findings were directly communicated to Dr. ___ was\npresent during real-time imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Successful CT-guided placement of two 10 ___ catheters into two seromas in\nthe anterolateral abdominal wall, with samples sent for microbiology.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ncollection. Samples was sent for microbiology evaluation." + }, + { + "input": "The superior left breast was scanned in the area that was described is firm\nand inflamed tissue is noted without an isolated fluid collection. The inner\nleft breast was also scanned in which there is minimally thickened skin\nmeasuring up to 0.6 cm. There is a small fluid collection measuring up to 1.4\nx 1.1 x 0.6 cm that has a simple appearance. On real-time scanning this fluid\ncollection is quite small relative to the marked inflammation of the breast.\n\nGiven the small size of the fluid collection, a decision was made with Dr.\n___ to defer drainage at this time.", + "output": "Marked inflammation of the reconstructed left breast with trace simple fluid\nalong the medial aspect.\n\nRECOMMENDATION(S): Clinical follow-up.\n\nNOTIFICATION: Findings reviewed with the patient and ___ At the\ncompletion of the study.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Scans of the upper and lower abdomen were performed demonstrating small volume\nascites in the perihepatic and perisplenic regions as well as in the right and\nleft lower quadrants. There is also right and left pleural effusion present.", + "output": "Small volume ascites. There is sufficient volume for a diagnostic\nparacentesis, once coagulopathy has been corrected." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.5 L of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic paracentesis, yielding 1.5\nL of clear, straw-colored ascitic fluid. Fluid samples were submitted to the\nlaboratory for cell count, differential, and culture." + }, + { + "input": "Transabdominal images of the uterus were obtained for intraoperative\nultrasound-guided D&C with Dr. ___. A total of 18 images were obtained.", + "output": "Intraoperative ultrasound guidance was provided." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 139 cm/sec.\nThe peak systolic and diastolic velocities in the proximal, mid, and distal\nright internal carotid artery are 129, 122, and 102 cm/sec, respectively.\nThe ICA/CCA ratio is 0.93.\nThe external carotid artery has peak systolic velocity of 139 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 128 cm/sec.\nThe peak systolic and diastolic velocities in the proximal, mid, and distal\nleft internal carotid artery are 115, 103, and 89 cm/sec, respectively.\nThe ICA/CCA ratio is 0.90.\nThe external carotid artery has peak systolic velocity of 187 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Moderate heterogeneous atherosclerotic plaque bilaterally resulting in 40-59%\nstenosis of both ICAs." + }, + { + "input": "Targeted ultrasound of the right upper inner quadrant at 1 o'clock 7 cm from\nthe nipple demonstrates an oval hypoechoic circumscribed 8 x 6 x 5 mm mass\nwith no internal dominant vascularity but of prominent adjacent vessel. There\nis no shadowing or through transmission. There may be a small calcification\nwithin the lesion, as noted on mammography MLO tomosynthesis slice 39.", + "output": "Indeterminate 8 mm right breast mass at 1 o'clock. While possibly a\nfibroadenoma, ultrasound core biopsy and clip placement is recommended for\ndefinitive pathology.\n\nRECOMMENDATION(S): Right breast ultrasound-guided core biopsy with clip\nplacement.\n\nNOTIFICATION: The finding and recommendation were discussed with the patient\nwith the assistance of a ___ interpreter available by phone. The patient\nunderstands and will schedule this biopsy.\nDr. ___ her office will be contacted for appropriate biopsy orders. \nPreliminary email was sent at 14:07 with request for biopsy orders.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Targeted ultrasound of the right breast at 1 o'clock 5-7 cm from the nipple\nagain demonstrates an oval hypoechoic circumscribed mass measuring\napproximately 8 x 5 x 7 mm without internal vascularity.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___, M.D.. The procedure was supervised by ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle and 14-gauge Bard spring-loaded biopsy\ndevicewere used to obtain 5 cores. Next, a percutaneous ribbon clip was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 3 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: The patient tolerated the procedure well and had a small <2 cm\nhematoma.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the targeted mass in the right upper inner breast.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted ultrasound of the right breast at 1 o'clock 5-7 cm from the nipple\nagain demonstrates an oval hypoechoic circumscribed mass measuring\napproximately 8 x 5 x 7 mm without internal vascularity.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___, M.D.. The procedure was supervised by ___,\nM.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle and 14-gauge Bard spring-loaded biopsy\ndevicewere used to obtain 5 cores. Next, a percutaneous ribbon clip was\ndeployed under ultrasound guidance.\n\nEstimated blood loss: < 3 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: The patient tolerated the procedure well and had a small <2 cm\nhematoma.\nPost procedure diagnosis: Same.\nStandard post care instructions were provided to the patient.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement within the targeted mass in the right upper inner breast.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 83 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 70 cm/s, 86 cm/s, and 67 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 29 cm/sec.\nThe ICA/CCA ratio is 1.\nThe external carotid artery has peak systolic velocity of91 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 70 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 84 cm/s, 102 cm/s, and 79 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 36 cm/sec.\nThe ICA/CCA ratio is .\nThe external carotid artery has peak systolic velocity of 86 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Right carotid atherosclerotic disease with stenosis less than 40%.\n2. Normal left carotid vasculature without evidence of any significant\natherosclerotic disease." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has homogeneous occlusive plaque.\nThe peak systolic velocity in the right common carotid artery is 77 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 0, 0, and 0 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 0\ncm/sec.\nThe external carotid artery has peak systolic velocity of 130 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 83, 94, and 110 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 44\ncm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 135 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA is occluded.\nLeft ICA <40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n85/22 cm/sec in its proximal portion, 89/24 cm/sec in its mid portion, and\n74/23 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n96/17 cm/sec.\nThe external carotid artery has peak systolic velocity of 119 cm/sec.\nThe vertebral artery has peak systolic velocity of 47 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 0.93.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n94/18 cm/sec in its proximal portion, 87/23 cm/sec in its mid portion, and\n104/33 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of\n102/19 cm/sec.\nThe external carotid artery has peak systolic velocity of 135 cm/sec.\nThe vertebral artery has peak systolic velocity of 54 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.", + "output": "Less than 40% stenoses of the bilateral internal carotid arteries due to mild\natherosclerosis." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a circumscribed dense oval mass in the upper central right breast. \nIn addition, multiple small circumscribed masses are noted in the inner lower\nright breast (2 can be seen on tomosynthesis images ___ and ___.)\n\nThere are benign-appearing dystrophic and vascular calcifications within both\nbreasts. A more focal group of calcifications is seen within the upper outer\nright breast posterior depth which on magnification views are coarse and\nsimilar in appearance to the other calcifications within the breast.\n\nThere are postsurgical changes related to treatment of patient's left breast\ncancer. Asymmetric density is noted in the central, slightly outer, and\nslightly upper anterior left breast. As no prior images are available, it is\nnot clear whether this represents abnormal density or is just related to post\nsurgical changes.\n\nRIGHT BREAST ULTRASOUND: At the 12 to 1:00 position right breast 3 cm from\nthe nipple there is a hypoechoic circumscribed oval mass with parallel\norientation measuring 1.3 x 0.8 x 1.5 cm which corresponds to dominant mass\nseen on mammogram. No significant internal color flow.\n\nThere is a similar-appearing mass at the 4 to 5:00 position right breast 2 cm\nfrom the nipple measuring 0.3 x 0.2 x 0.4 cm. T\n\nHere is a similar appearing mass at the 2 o'clock position right breast 6 cm\nthe nipple demonstrating 0.4 x 0.2 x 0.5 cm.\n\nLEFT BREAST ULTRASOUND: Ultrasound performed at the 2 o'clock, 4 o'clock, and\n5 o'clock positions left breast 4-8 cm of the nipple area was performed to\nevaluate the area of clinical concern in the upper outer left breast and the\nasymmetric density seen on mammography. There is no cystic or solid mass\nidentified.", + "output": "1. No definite findings on mammogram or ultrasounds to account for patient's\npain left breast.\n\n2. Probably benign right breast masses. Review of outside reports suggest\nthat these masses are stable however films are not available for direct visual\ncomparison and therefore if prior studies become available an addendum will be\nissued.\n\n3. Probably benign right breast calcifications in the upper posterior right\nbreast.\n\n4. Asymmetric tissue involving the outer left breast likely represents normal\npostsurgical changes. However, in the absence of prior imaging for\ncomparison, this area is indeterminate.\n\nRECOMMENDATION(S): 1. Clinical followup for left breast pain.\n\n2. six-month follow-up bilateral mammogram to follow the left breast\nasymmetry, right breast masses, and right breast calcifications is\nrecommended. At that time, right breast ultrasound may be performed for the\nmasses noted on sonography.\n\n3. Should the outside imaging become available, an addendum will be issued.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a circumscribed dense oval mass in the upper central right breast. \nIn addition, multiple small circumscribed masses are noted in the inner lower\nright breast (2 can be seen on tomosynthesis images ___ and ___.)\n\nThere are benign-appearing dystrophic and vascular calcifications within both\nbreasts. A more focal group of calcifications is seen within the upper outer\nright breast posterior depth which on magnification views are coarse and\nsimilar in appearance to the other calcifications within the breast.\n\nThere are postsurgical changes related to treatment of patient's left breast\ncancer. Asymmetric density is noted in the central, slightly outer, and\nslightly upper anterior left breast. As no prior images are available, it is\nnot clear whether this represents abnormal density or is just related to post\nsurgical changes.\n\nRIGHT BREAST ULTRASOUND: At the 12 to 1:00 position right breast 3 cm from\nthe nipple there is a hypoechoic circumscribed oval mass with parallel\norientation measuring 1.3 x 0.8 x 1.5 cm which corresponds to dominant mass\nseen on mammogram. No significant internal color flow.\n\nThere is a similar-appearing mass at the 4 to 5:00 position right breast 2 cm\nfrom the nipple measuring 0.3 x 0.2 x 0.4 cm. T\n\nHere is a similar appearing mass at the 2 o'clock position right breast 6 cm\nthe nipple demonstrating 0.4 x 0.2 x 0.5 cm.\n\nLEFT BREAST ULTRASOUND: Ultrasound performed at the 2 o'clock, 4 o'clock, and\n5 o'clock positions left breast 4-8 cm of the nipple area was performed to\nevaluate the area of clinical concern in the upper outer left breast and the\nasymmetric density seen on mammography. There is no cystic or solid mass\nidentified.", + "output": "1. No definite findings on mammogram or ultrasounds to account for patient's\npain left breast.\n\n2. Probably benign right breast masses. Review of outside reports suggest\nthat these masses are stable however films are not available for direct visual\ncomparison and therefore if prior studies become available an addendum will be\nissued.\n\n3. Probably benign right breast calcifications in the upper posterior right\nbreast.\n\n4. Asymmetric tissue involving the outer left breast likely represents normal\npostsurgical changes. However, in the absence of prior imaging for\ncomparison, this area is indeterminate.\n\nRECOMMENDATION(S): 1. Clinical followup for left breast pain.\n\n2. six-month follow-up bilateral mammogram to follow the left breast\nasymmetry, right breast masses, and right breast calcifications is\nrecommended. At that time, right breast ultrasound may be performed for the\nmasses noted on sonography.\n\n3. Should the outside imaging become available, an addendum will be issued.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 63 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 91, 92, and 56 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 67, 67, and 50 a cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 0.76.\nThe external carotid artery has peak systolic velocity of 79 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis in internal carotid arteries bilaterally." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: 0.5 mg subcutaneous hydromorphone throughout the total\nintra-service time of 10 minutes during which patient's hemodynamic parameters\nwere continuously monitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 9.75 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 9.75 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8.1 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key\ncomponents of the procedure and reviewed and agrees with the trainee's\nfindings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant. Initial drainage displayed bloody fluid in 2 L was initially\ndrain. Following this Hepatology was consulted and the decision was made to\nproceed with 4 L total of sanguinous fluid removed with conversion to\ndiagnostic and therapeutic paracentesis with 20 cc drawn for lab work. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated frank blood loss was minimal with no clotting identified in the\ncontainers ___ years or in the syringes used for diagnostic evaluation.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4 L of sanguinous fluid were removed.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. in person on ___ at 12:15 pm, 5 minutes after discovery of\nthe findings." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 7.4 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 7.4 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.5 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed.\n3. The patient was in a hemodynamically stable condition at the time of\ndischarge to the RCU for administration of Albumin." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was renewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.5 L of heme-tinged fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.75 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.75 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.0 L of clear, yellow-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound-guided therapeutic paracentesis.\n2. 5.0 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.6 L of clear, yellow-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 5.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 4.8 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 4.8 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 3.7 L of clear, yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 3.7 L of clear yellow fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nlower quadrant and 2.9 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.9 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated small amount\nof ascites. A suitable target in the deepest pocket in the right upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 1.5 L of clear yellow fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.5 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 200 mL of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 200 mL of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.9 L of serosanguinous fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.9 L of serosanguinous fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right upper quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nupper quadrant and 2.1 L of dark orange fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.1 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 20 cc of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis. \nInsufficient fluid was identified for therapeutic paracentesis.\n2. 20 cc of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2.6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2.6 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 2 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 2 L of fluid were removed." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 7 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 1.6 L of clear, straw-colored fluid were removed.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided therapeutic paracentesis.\n2. 1.6 L of fluid were removed." + }, + { + "input": "The subcapsular mass in the posterior aspect of the liver measures 5.6 cm. \nThis mass is better seen with breath-holding and could be amenable to biopsy\nvia anterior intercostal approach, however given poor visualization when\npatient is not breath-holding, its superior and posterior location, CT may be\na better modality for percutaneous biopsy.", + "output": "The posterior right hepatic mass is amenable to biopsy by ultrasound, however\nit may be challenging as it is posterior and only seen during breath-holding. \nConsider CT for percutaneous biopsy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nRight breast: Again seen is a 0.6 cm spiculated mass with indistinct borders\nin the posterior upper outer right breast. This was further evaluated with\nultrasound. A focal asymmetry in the slightly medial central breast is stable\nsince ___ consistent with a benign process. Additional asymmetries seen in\nthe anterior breast do not persist with compression views and likely represent\npliable breast tissue. These areas were further evaluated via ultrasound. \nThere is no evidence of concerning micro calcifications or architectural\ndistortion. Scattered benign-appearing round calcifications are seen in the\nanterior breast.\n\nBREAST ULTRASOUND:\nTargeted ultrasound was performed of the right breast. At the 10 o'clock\nposition, 9 cm from the nipple, there is a hypoechoic solid anti parallel mass\nmeasuring 0.4 x 0.5 x 0.4 cm, which is suspicious for malignancy. Targeted\nultrasound was performed in the areas of the anterior asymmetries from ___\no'clock and 3 to 6 o'clock 0-5 cm from the nipple. No suspicious solid or\ncystic masses identified in these areas.", + "output": "1. Suspicious mass in the right breast at 10 o'clock for which ultrasound\nguided biopsy is recommended.\n2. Other asymmetries in the right breast are compatible with a benign process.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of mass located at the 10\no'clock position, 9 cm from the nipple.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was given information to schedule her\nbiopsy.\n\nThe impression and recommendation above was entered by Dr. ___ on\n___ at 15:09 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Targeted ultrasound was performed of the right breast. At the 10 o'clock, 9\ncm from the nipple, a 6 mm hypoechoic mass with indistinct margins with seen\nand targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ the procedure was supervised by ___, M.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesions.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nresident's findings and dictation." + }, + { + "input": "Targeted ultrasound was performed of the right breast. At the 10 o'clock, 9\ncm from the nipple, a 6 mm hypoechoic mass with indistinct margins with seen\nand targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___ the procedure was supervised by ___, M.D..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesions.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nresident's findings and dictation." + }, + { + "input": "Targeted ultrasound the right breast at ___ o'clock 8-12 cm from the nipple\ndemonstrates a 6.1 x 2.8 x 6.0 cm fluid collection with internal septations\nmost consistent with a postoperative seroma cavity. There is no evidence to\nsuggest abscess formation.", + "output": "6.1 cm right upper outer quadrant seroma cavity.\n\nRECOMMENDATION(S): The seroma is symptomatic for the patient and request for\naspiration was made.\n\nNOTIFICATION: Findings were discussed with the patient and request for\naspiration was made. This was scheduled for later same day.\n\nBI-RADS: 2 Benign." + }, + { + "input": "At 11 o'clock, 11-12 cm from the nipple near the axilla and under the scar,\nagain seen is a fluid collection with internal septation, most consistent with\na postoperative seroma. This was targeted for ultrasound-guided drainage. \nThe aspirated fluid appeared straw-colored and clear and was discarded. \nDuring the aspiration, the fluid collection decreased in size and at the end\nof the procedure, no discrete fluid collection remained.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___. and ___, M.D..\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the lesion and aspirated.\n50 cc of fluid was drained. The fluid was discarded due to lack of suspicion.\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast postoperative seroma cavity.\nStandard post care instructions were provided to the patient.", + "output": "Technically successful US-guided aspiration of the right breast postoperative\nseroma.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation.\n\nRECOMMENDATION(S): Age and risk appropriate screening." + }, + { + "input": "At 11:00 position 11 cm from the nipple there is a 5 x 5 x 2.3 cm complicated\nfluid collection, consistent with recurrent seroma.", + "output": "Recurrent seroma in the right lumpectomy bed.\n\nRECOMMENDATION(S): Clinical follow-up is recommended. Ultrasound-guided cyst\naspiration is requested by the referring clinician and is dictated separately.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Again seen in the right breast at 10 o'clock 9 cm from the nipple is an\nanechoic fluid collection measuring 4.33 x 2.21 x 4.96. There are internal\nseptations noted.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: N. ___. and ___, M.D..\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 16 gauge needle was placed into the lesion and 40 cc of\nclear yellow fluid was aspirated.. The fluid was discarded due to lack of\nsuspicion.\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated right breast seroma\nStandard post care instructions were provided to the patient.", + "output": "Technically successful US-guided aspiration of the right breast seroma\n\nRECOMMENDATION(S): Follow-up as clinically indicated. Annual mammography is\ndue ___." + }, + { + "input": "In the right breast at 10 o'clock 9 cm from the nipple, there is a 4.8 x 3.3 x\n5.7 cm avascular fluid collection with multiple internal septations.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D., N. ___. and ___, M.D..\n\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the lesion and 45 cc of\nclear, straw-colored fluid was removed. The fluid was discarded due to lack\nof suspicion.\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast cyst.\nStandard post care instructions were provided to the patient.", + "output": "Technically successful US-guided aspiration of the right breast cyst/seroma.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation.\n\nRECOMMENDATION(S): Clinical follow-up." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is fibroglandular breast tissue in the retroareolar regions bilaterally,\ngreater on the left. The appearance is consistent with gynecomastia, moderate\non the left and mild on the right. There is no dominant mass, architectural\ndistortion or suspicious grouped microcalcifications. A few scattered benign\ncalcifications are noted, some of which are in the skin.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left retroareolar region was\nperformed. There is hypoechoic glandular tissue in the retroareolar region\nmeasuring 3.3 cm x0.9 cm consistent with moderate gynecomastia. There are no\nsuspicious solid or cystic masses. Scanning of the left axilla demonstrates\nnormal appearance of axillary lymph nodes.\n\nScanning of the right retroareolar region for comparison demonstrates mild\nretroareolar glandular tissue.", + "output": "Bilateral gynecomastia, moderate on the left and mild on the right. No\nevidence of malignancy.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 86 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 50, 46, and 83 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 0.97.\nThe external carotid artery has peak systolic velocity of 56 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 66, 46, and 60 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.87.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Minimal left internal carotid artery atherosclerotic (0% stenosis on the\nright, and ___ stenosis on the left)." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere is a suspicious, pleomorphic group of 4 microcalcifications that do not\nlayer in the mid left breast new from ___. The 1.2 cm asymmetry in the left\ncentral slightly outer breast is stable since ___. The second adjacent\nassymetry is pliable on spot compression views and is adjacent to the\nsuspicious microcalcfications. There is no associated unexplained\narchitectural distortion.\n\nTargeted ultrasound of the left breast from ___, in the area of\nmammographic and clinical concern demonstrated at 3:30, 4 cm from the nipple,\na 7 x 5 x 4-mm ill-defined, hypoechoic, heterogeneous, and irregular mass with\nposterior features but no dominant vascularity. Immediately adjacent to the\nsuspicious lesion, there are several echogenic foci that likely correspond to\nthe suspicious group of calcifications demonstrated on mammography.The total\narea of the mass and calcifications measure approx 1.3 cm on ultrasound.\n\nAt 1:00, 6 cm from the nipple, there is a 8 x 7 x 3-mm well-defined,\nheterogeneous lesion without internal vascularity or posterior features, which\nis most likely a fibroadenoma.\nThe area measured at 12:00 on the images represents normal breast tissue.\n\nTargeted ultrasound of the left axilla failed to demonstrate any suspicious\nlymph nodes.", + "output": "1) Highly suspicious 7-mm left breast mass with associated nearby pleomorphic\nmicrocalcifications on mammography and ultrasound (3:30, 4 cm from the\nnipple).\n\n2) 1.2 cm asymmetry in the left central slightly outer breast is stable since\n___.\n\n3) Probably benign lesion in the left breast at 1:00 could represent a\nfibradenoma.\n\nRECOMMENDATION: Ultrasound-guided core biopsy was recommended for the left\nbreast mass. However, the patient indicates that she will not be able to\ntolerate such a biopsy and would prefer a needle localization and surgical\nexcisional biopsy.\n\nNOTIFICATION: Findings were reviewed with the patient and her friend at the\ncompletion of the study. The patient was given a business card for the breast\ncare center.\n\n The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 5:40 ___, 15 minutes after discovery of the\nfindings. Dr. ___ will discuss with the patient make the referral for\nthe patient to the breast care center.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nThere is a suspicious, pleomorphic group of 4 microcalcifications that do not\nlayer in the mid left breast new from ___. The 1.2 cm asymmetry in the left\ncentral slightly outer breast is stable since ___. The second adjacent\nassymetry is pliable on spot compression views and is adjacent to the\nsuspicious microcalcfications. There is no associated unexplained\narchitectural distortion.\n\nTargeted ultrasound of the left breast from ___, in the area of\nmammographic and clinical concern demonstrated at 3:30, 4 cm from the nipple,\na 7 x 5 x 4-mm ill-defined, hypoechoic, heterogeneous, and irregular mass with\nposterior features but no dominant vascularity. Immediately adjacent to the\nsuspicious lesion, there are several echogenic foci that likely correspond to\nthe suspicious group of calcifications demonstrated on mammography.The total\narea of the mass and calcifications measure approx 1.3 cm on ultrasound.\n\nAt 1:00, 6 cm from the nipple, there is a 8 x 7 x 3-mm well-defined,\nheterogeneous lesion without internal vascularity or posterior features, which\nis most likely a fibroadenoma.\nThe area measured at 12:00 on the images represents normal breast tissue.\n\nTargeted ultrasound of the left axilla failed to demonstrate any suspicious\nlymph nodes.", + "output": "1) Highly suspicious 7-mm left breast mass with associated nearby pleomorphic\nmicrocalcifications on mammography and ultrasound (3:30, 4 cm from the\nnipple).\n\n2) 1.2 cm asymmetry in the left central slightly outer breast is stable since\n___.\n\n3) Probably benign lesion in the left breast at 1:00 could represent a\nfibradenoma.\n\nRECOMMENDATION: Ultrasound-guided core biopsy was recommended for the left\nbreast mass. However, the patient indicates that she will not be able to\ntolerate such a biopsy and would prefer a needle localization and surgical\nexcisional biopsy.\n\nNOTIFICATION: Findings were reviewed with the patient and her friend at the\ncompletion of the study. The patient was given a business card for the breast\ncare center.\n\n The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 5:40 ___, 15 minutes after discovery of the\nfindings. Dr. ___ will discuss with the patient make the referral for\nthe patient to the breast care center.\n\nBI-RADS: 4C Suspicious - high suspicion for malignancy." + }, + { + "input": "No lymphadenopathy is detected. A hypodense lesion seen on the recent\nreference CT examination from ___, corresponds to a slow-flow varix\non the ultrasound examination from the internal jugular, new since the chest\nCT examination from ___, likely secondary to recent SVC\nobstruction. There are no fluid collections.", + "output": "No lymphadenopathy. No biopsy candidate detected within the right or left\nneck." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has heterogeneous plaque with more focal plaque\nin the proximal right internal carotid artery\nThe peak systolic velocity in the right common carotid artery is 88 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 96, 105, and 82 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 92 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 72 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 65, 75, and 69 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 30 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 91 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Bilateral heterogeneous plaque with more focal plaque in the proximal right\ninternal carotid artery. There are no significantly elevated internal carotid\nartery systolic velocities to suggest a hemodynamically significant focal\nstenosis by ultrasound criteria." + }, + { + "input": "The aorta measures 2.9 cm in the proximal portion, 2.2 cm in mid portion and\n2.1 cm in the distal abdominal aorta. There are mild calcified\natherosclerotic plaque.\n\nWall-to-wall color flow is seen within aorta with appropriate arterial\nwaveforms.\n\nThe right common iliac artery measures 1.1 cm and the left common iliac artery\nmeasures 1.3 cm.\n\nThe right kidney measures 11.9 cm. The patient is status post left\nnephrectomy. Limited views of the right kidney demonstrates mild\nhydronephrosis, unchanged from prior.", + "output": "1. No evidence of abdominal aortic aneurysm.\n2. Stable mild right hydronephrosis." + }, + { + "input": "The liver shows increased echogenicity. There is no evidence of intrahepatic\nor extrahepatic biliary dilatation. Patient is status postcholecystectomy. The\ncommon bile duct measures up to 1 cm and tapers adequately intrahepatically.\nHowever, note is made of a cut off at the extrahepatic CBD with no definite\nfilling defect or stones identified. Visualized portions of the pancreas are\nwithin normal limits with no evidence of pancreatic ductal dilatation. Note is\nmade of a 5 mm echogenic focus in the upper pole of the right kidney, which\ncould reflect a tiny AML. Representative images of the right kidney are\notherwise within normal limits. The right kidney measures 11.5 cm.", + "output": "1. Echogenic liver could relate to fatty deposition. Other forms of liver\ndisease and more advanced liver disease including significant hepatic\nfibrosis/cirrhosis cannot be excluded on this study.\n\n2. Patient is status postcholecystectomy. No evidence of intra or extrahepatic\nbiliary ductal dilatation. The common bile duct measures up to 1 cm and tapers\nadequately intrahepatically. However note is made of a cutoff at the\nextrahepatic CBD with no definite filling defect or stones identified. Further\nexamination with ERCP or MRCP is recommended. As per patient, she is\nscheduled for ERCP on ___." + }, + { + "input": "The aorta is ectatic measuring 2.8 cm in the proximal portion, 2.4 cm in mid\nportion and 2.3 cm in the distal abdominal aorta. There is mild calcified\natherosclerotic plaque.\n\nWall-to-wall color flow is seen within the aorta with appropriate arterial\nwaveforms.\n\nThe iliac arteries are also noted to be mildly ectatic. Right common iliac\nartery measures 1.4 cm and the left common iliac artery measures 1.6 cm.\n\nThe right kidney measures 12.7 cm cm and the left kidney measures 12.8 cm cm.\nLimited views of the kidneys are unremarkable without hydronephrosis.\n\nOn limited views of the right upper quadrant the liver is incidentally noted\nto be diffusely echogenic consistent with steatosis.", + "output": "1. Ectatic abdominal aorta however no evidence of abdominal aortic aneurysm.\n2. Echogenic liver consistent with steatosis seen on limited views. Other\nforms of liver disease and more advanced liver disease including\nsteatohepatitis or significant hepatic fibrosis/cirrhosis cannot be excluded\non this study.\n\nRECOMMENDATION(S): Radiological evidence of fatty liver does not exclude\ncirrhosis or significant liver fibrosis which could be further evaluated by\n___. This can be requested via the ___ (FibroScan) or the\nRadiology Department with either MR ___ or US ___, in\nconjunction with a GI/Hepatology consultation\" *\n\n* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver\ndisease: Practice guidance from the ___ Association for the Study of\nLiver Diseases. Hepatology ___ 67(1):328-357" + }, + { + "input": "SPLEEN: Transverse and sagittal images were obtained of the spleen in the\nleft upper quadrant. The spleen measures 13.5 cm. No focal abnormality is\nseen within the spleen.", + "output": "The spleen is borderline in length but probably represents the upper limits of\nnormal by volume and shape. No splenic abnormality identified." + }, + { + "input": "1. Distended gallbladder with sludge is present.\n\n2. Successful percutaneous placement of an 8 ___ catheter into the\ngallbladder using ultrasound guidance.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "Targeted ultrasound of the right upper quadrant demonstrated a subhepatic\nfluid collection compatible with the gallbladder fossa fluid collection seen\non same day CT abdomen pelvis.\n\nApproximately 80 cc of purulent fluid was drained from the fluid collection\nupon placement of the drain.", + "output": "Successful ultrasound and fluoroscopic-guided placement of ___ pigtail\ncatheter into the collection. Samples was sent for microbiology evaluation." + }, + { + "input": "There is a trace perihepatic ascites. When comparing to the recent CT there\nis suggestion of a 1 cm enhancing focus in the right lobe of the liver,\nwithout definite US correlate. Given this finding and underlying nodularity\nof the liver, MRI is recommended for further evaluation.", + "output": "Trace perihepatic ascites. Suggestion of 1 cm enhancing focus in the right\nlobe of the liver, not seen on US. Liver MRI is recommended to rule out\nunderlying lesion.\n\nRECOMMENDATION(S): Liver MRI" + }, + { + "input": "The spleen is normal in echotexture and measures 12.5 cm. There is no splenic\nlesion seen.", + "output": "12.5 cm spleen, stable compared to an MRI from ___." + }, + { + "input": "The uterus is retroflexed. The uterus mildly enlarged without focal masses\nand measures 9.8 x 4.2 x 6.3 cm. The endometrium is homogenous and measures 6\nmm.\n\nThe ovaries are normal with a 2.9 cm hemorrhagic corpus luteum on the right.\nThere is a trace amount of free fluid.", + "output": "Normal pelvic ultrasound.\n\nNOTIFICATION: The findings were discussed with ___ by ___\n___ on the telephone on ___ at 11:30AM, 5 minutes after discovery\nof the findings." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nAdditional spot evaluation shows a small, approximately 0.3 cm rounded\nasymmetry in the upper aspect of the breast which is at an anterior depth. It\nis this is not clearly seen on the second projection. This seems to been\npresent in ___ and appears different because of the interval surgery. \nTargeted ultrasound was performed.\n\nBREAST ULTRASOUND: Scanning from the 11 to 1 o'clock position shows 2\nadjacent anechoic structures at the 11 o'clock position and 3 cm from the\nnipple at an anterior depth. Maximum dimension is 0.2 x 0.4 x 0.5 cm. There\nis no associated vascularity or shadowing. This finding is felt to correspond\nwith the mammographic asymmetry.", + "output": "Left breast asymmetry corresponds with 2 adjacent simple cysts on same-day\nultrasound.\n\nRECOMMENDATION(S): Routine screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There is a 0.4 x 1.2 x 1.9 cm simple cyst along the 6 o'clock axis at a\ndistance of approximately 1 cm from the nipple. This is at a posterior depth.\nThere are no solid masses seen.", + "output": "Simple cyst is seen on today's evaluation of the right breast.\n\nRECOMMENDATION(S): Clinical followup.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\nFentanyl and Versed throughout the total intra-service time of 12 minutes\nduring which the patient's hemodynamic parameters were continuously monitored\nby an independent, trained radiology nurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe BB marker in the slightly upper, slightly outer right breast denotes the\nsite of palpable concern as indicated by the patient. Underlying the BB,\nthere is nodular appearing breast parenchyma. This was further evaluated with\ntargeted breast ultrasound. A group of calcifications in the slightly inner,\ncentral to slightly lower left breast at posterior depth layer on the lateral\nview, consistent with benign milk of calcium. A more discrete group in the\ncentral left breast on magnification views are benign in morphology, similar\nto other scattered calcifications. Scattered calcifications are seen\nbilaterally without suspicious groups. There is no spiculated mass or\nunexplained architectural distortion in either breast.\n\nRIGHT BREAST ULTRASOUND: Targeted ultrasound was performed in the area of\npalpable concern as indicated by the patient. At 11 o'clock 0 cm from the\nnipple in the right breast, there is a 0.8 x 0.8 x 0.4 cm lobulated hypoechoic\nmass that appears to be in continuity with a duct. There is prominent\nperipheral vascularity without dominant posterior features. At 10 o'clock 3\ncm from the nipple, there is a 0.5 cm round nearly anechoic mass with\nincreased through-transmission on real-time scanning, which is felt to\nrepresent a benign cyst.", + "output": "Indeterminate 0.8 cm mass at 11 o'clock in the right breast may correspond to\nthe area of palpable concern. This likely represents an intraductal mass such\nas papilloma.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy of the right breast mass is\nrecommended, preferably with vacuum assistance.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient via an interpreter. She agrees with this plan. She was given\ninformation to schedule her biopsy. The above was communicated by Dr. ___\n___ to Dr. ___ email on ___.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Right breast ultrasound ___, diagnostic mammogram bilateral ___\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___. ___, N.P.. The procedure was supervised by\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 11-gauge coaxial needle was placed adjacent to the inferior\naspect of the lesion and multiple cores were obtained using a 12-gauge ATEC\nvacuum-assisted biopsy device. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm clip placement in the\nslightly upper and central right breast without any associated mass. The\ntargeted lesion did not have clear mammographic finding on prior mammogram. \nNo significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Right breast ultrasound ___, diagnostic mammogram bilateral ___\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D. ___. ___, N.P.. The procedure was supervised by\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 11-gauge coaxial needle was placed adjacent to the inferior\naspect of the lesion and multiple cores were obtained using a 12-gauge ATEC\nvacuum-assisted biopsy device. Next, a percutaneous HydroMark coil was\ndeployed under ultrasound guidance. The needle was removed and hemostasis was\nachieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm clip placement in the\nslightly upper and central right breast without any associated mass. The\ntargeted lesion did not have clear mammographic finding on prior mammogram. \nNo significant hematoma is seen.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "In the right breast at ___ o'clock 2 cm from the nipple, there is a 6 x 4 x 5\nmm benign anechoic avascular cyst.", + "output": "Benign 6 mm cyst in the right breast corresponding to the mass seen on\nmammogram.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nAdditional views demonstrate normal breast parenchyma without underlying\ndominant mass, focal asymmetry, or architectural distortion. There are few\nscattered benign calcifications but no suspicious groups. The area of prior\nconcern is no longer present, likely overlapping glandular tissue.\n\nBREAST ULTRASOUND: Scanning of the left lateral breast from 1 o'clock through\n5 o'clock demonstrates normal scattered fibroglandular tissue without\nunderlying suspicious solid or cystic mass.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION(S): Annual screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "There are no suspicious solid or cystic masses", + "output": "Normal left breast ultrasound\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has minimal heterogeneous atherosclerotic\nplaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n53/17 cm/sec in its proximal portion, 58/19 cm/sec in its mid portion, and\n70/21 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n80/19 cm/sec.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery has peak systolic velocity of 39 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 0.87.\n\nLEFT:\nThe left carotid vasculature has minimal heterogeneous atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n53/21 cm/sec in its proximal portion, 73/28 cm/sec in its mid portion, and\n88/26 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 63/17\ncm/sec.\nThe external carotid artery has peak systolic velocity of 72 cm/sec.\nThe vertebral artery has peak systolic velocity of 53 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.3.", + "output": "1. Minimal heterogeneous plaque in the bilateral proximal internal carotid\narteries with less than 40% stenosis bilaterally." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. There is a persistent 0.6 cm circumscribed mass in the\nslightly lower outer left breast which was further evaluated with ultrasound.\n\nUltrasound of the left breast at 4 o'clock 4 cm from the nipple 0.5 x 0.5 x\n0.3 cm simple cyst which is felt to correspond to the mammographic finding. \nIn addition, there is a contiguous 0.3 x 0.2 x 0.2 cm cystic appearing mass\nwith homogeneous internal echoes most likely representing a complicated cyst. \nOptions of followup imaging in six months versus ultrasound-guided cyst\naspiration were discussed with the patient. The patient would prefer to have\na definitive diagnosis and therefore would like to proceed ahead with an\nultrasound-guided aspiration of both lesions.", + "output": "0.5 x 0.5 x 0.3 cm simple cyst in the left breast likely accounting for the\nmammographic finding seen on the screening study ___. Contiguous\nprobable benign complicated cyst. Although followup imaging could be\nperformed, the patient would prefer definitive diagnosis and therefore has\nbeen scheduled to undergo this procedure following completion of the\ndiagnostic evaluation.\n\nRECOMMENDATION: Left breast ultrasound-guided cyst aspiration.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. The\npatient would like to undergo ultrasound-guided cyst aspiration to obtain a\ndefinitive diagnosis following completion of the diagnostic mammogram. \nResults were also communicated to Dr. ___, the covering physician\nfor Dr. ___, by phone on ___ at 10:40.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - The breast tissues are fatty with some scattered\nfibroglandular tissue. There is a persistent 0.6 cm circumscribed mass in the\nslightly lower outer left breast which was further evaluated with ultrasound.\n\nUltrasound of the left breast at 4 o'clock 4 cm from the nipple 0.5 x 0.5 x\n0.3 cm simple cyst which is felt to correspond to the mammographic finding. \nIn addition, there is a contiguous 0.3 x 0.2 x 0.2 cm cystic appearing mass\nwith homogeneous internal echoes most likely representing a complicated cyst. \nOptions of followup imaging in six months versus ultrasound-guided cyst\naspiration were discussed with the patient. The patient would prefer to have\na definitive diagnosis and therefore would like to proceed ahead with an\nultrasound-guided aspiration of both lesions.", + "output": "0.5 x 0.5 x 0.3 cm simple cyst in the left breast likely accounting for the\nmammographic finding seen on the screening study ___. Contiguous\nprobable benign complicated cyst. Although followup imaging could be\nperformed, the patient would prefer definitive diagnosis and therefore has\nbeen scheduled to undergo this procedure following completion of the\ndiagnostic evaluation.\n\nRECOMMENDATION: Left breast ultrasound-guided cyst aspiration.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging. The\npatient would like to undergo ultrasound-guided cyst aspiration to obtain a\ndefinitive diagnosis following completion of the diagnostic mammogram. \nResults were also communicated to Dr. ___, the covering physician\nfor Dr. ___, by phone on ___ at 10:40.\n\nBI-RADS: 2 Benign." + }, + { + "input": "In the left breast at 4 o'clock 4 cm from the nipple is a oval anechoic mass\nmeasuring 0.4 x 0.3 x 0.3 cm\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nTime-out certification: Performed using three patient identifiers. Allergies\nand/or Medications: Reviewed prior to the procedure.\nClinicians: ___, NP and ___, M.D..\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was advanced to the mass at 4 o'clock 4\ncm from the nipple and a scant amount of cyst fluid was aspirated. The fluid\nwas discarded due to lack of suspicion. The needle was removed and hemostasis\nwas achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated left breast cyst.\n\nPOST PROCEDURE MAMMOGRAM: CC and ML views of the left breast show resolution\nof the mass in the left breast. No significant hematoma is seen.", + "output": "Technically successful US-guided aspiration of the left breast cyst\ncorresponding to the mammographic finding. However, the smaller probable\ncomplicated cyst was not aspirated at this visit. The patient can either\nreturn in six months for a follow up ultrasound to assess for stability or\nreturn for a second aspiration. The plan is for ___ NP to\ncontact the patient to determine the preferred management plan.\n\nFindings reviewed with the patient at the completion of the aspiration.\n\nStandard post care instructions were provided to the patient." + }, + { + "input": "2-3 mm complicated cyst in the left breast at the 4 o'clock position,\napproximately 4 cm from the nipple.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___. ___ MD, resident, and ___, M.D. (Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, an 18 gauge needle was placed into the lesion and aspirated.\nThe fluid was discarded due to lack of suspicion. The needle was removed and\nhemostasis was achieved. The lesion completely resolved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: None.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast cyst.\nClinicians: ___ MD, resident, and ___, M.D.. The procedure was\nsupervised by P. ___, M.D. (Attending).", + "output": "Technically successful US-guided aspiration of the 2-3 mm left breast cyst.\n\nFindings reviewed with the patient at the completion of the aspiration.\n\nStandard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation.\n\nRECOMMENDATION(S): Age and risk appropriate screening." + }, + { + "input": "Within the gallbladder fossa, adjacent to the left portal vein there is a non\nloculated nondistended fluid pocket which is similar in size when compared to\nthe prior MRI study. It has a maximum dimension of 1.1 x 1.5 x 6 cm. It is\ncompatible the patient's known cystic duct stump leak. Few septations are\nidentified.", + "output": "Nondistended non loculated fluid collection within the gallbladder fossa which\nmeasures 1.1 x 1.5 x 6 cm. This is not significant changed from the prior MRI\nstudy.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:30 am, 10 minutes after\ndiscovery of the findings." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 44, 43, and 50 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 13\ncm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 94 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneousatherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 57 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 32, 44, and 62 cm/sec, respectively.\nThe peak end diastolic velocity in the left internal carotid artery is 17\ncm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 75 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nPost-treatment changes are demonstrated in the left breast in the region of\nthe surgical bed as denoted by the underlying scar marker. There is no\ndominant mass, architectural distortion, or suspicious group of\nmicrocalcifications in either breast. No significant interval change. A\nport-a-cath is incidentally demonstrated in the right axilla.\n\nTargeted ultrasound of the left breast from 9:00 through 3:00, 1-15 cm from\nthe nipple, including the in the area of clinical concern as reported by the\npatient and provider, demonstrates normal breast tissue and post-surgical\nchanges without any discrete solid or cystic mass. At 2:00, 11 cm from the\nnipple, the surgical scar is demonstrated with posterior shadowing.", + "output": "Stable post-treatment changes in the left breast. No specific mammographic or\nsonographic evidence of malignancy.\nNo imaging correlate for the area of clinical concern in the left breast as\nreported by the patient and provider.\n\nRECOMMENDATION: Clinical assessment in the region of concern.\nAge and risk specific screening.\n\nNOTIFICATION: Findings were reviewed with the patient at the completion of\nthe study by Dr. ___.\n\nBI-RADS: 2 Benign." + }, + { + "input": "This procedure was performed by the Nephrology team; please see Nephrology\nprocedure note for further details.\n\nReal-time ultrasound guidance for percutaneous renal biopsy was provided by\nradiologist. The lower pole of the left kidney was targeted and 2 biopsy\npasses performed.\n\nSEDATION: Moderate sedation was supervised by the Nephrology team, and\nprovided by administering divided doses of Fentanyl and Versed throughout the\ntotal intra-service time of 11minutes during which the patient's hemodynamic\nparameters were continuously monitored by an independent, trained radiology\nnurse.", + "output": "Ultrasound guidance for percutaneous left kidney biopsy." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the right\nlower quadrant and 5.1 L of clear, straw-colored fluid was removed. Fluid\nsamples were submitted to the laboratory for cell count and cytology.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "Technically successful ultrasound-guided diagnostic and therapeutic\nparacentesis with removal of 5.1 L of clear, straw-colored fluid from the\nright lower quadrant. Samples were sent to the laboratory as requested." + }, + { + "input": "Targeted ultrasound of the area of palpable concern in the outer left breast\nwas performed. There are no suspicious cystic or solid masses identified.", + "output": "There are no suspicious sonographic findings in the area of palpable concern\nin left breast.\n\nRECOMMENDATION(S): Clinical followup for left breast lump is recommended. \nFinal patient disposition and any decision to biopsy should be based on\nclinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 60 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 76, 65, and 77 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 150 cm/sec.\nThe vertebral artery is patent but demonstrates to and fro flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 73 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 60, 72, and 68 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 18 cm/sec.\nThe ICA/CCA ratio is 0.99.\nThe external carotid artery has peak systolic velocity of 164 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Mild bilateral carotid vasculature stenosis, under 40%.\n2. To and fro flow in the right vertebral artery." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 2.75 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested\nanalysis.\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nA BB was placed over the palpable area in the left breast. There is no\ndiscrete mass underlying the BB. There are no spiculated masses suspicious\ngrouped microcalcifications or areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound of the left breast was performed. \nThere is no discrete solid or cystic mass, underlying the palpable area which\nis at 7 o'clock 2 cm from the nipple.", + "output": "No evidence of malignancy.\n\nRECOMMENDATION(S): Final disposition of the palpable area should be based on\nclinical evaluation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Age and risk appropriate mammography recommended.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Preprocedural limited CT demonstrates a large 12.6 by 8.8 cm right axillary\nsolid mass with a calcified component inferiorly.\n\nRedemonstrated multiple bilateral pulmonary metastases, not significantly\nchanged from prior. There is a slight increase of bilateral small pleural\neffusions.\n\nAlso unchanged are severe coronary calcifications, aortic valve and mitral\nannulus calcification", + "output": "1. Successful ultrasound guided core biopsy x3 of the 12.6 cm right axillary\nsolid mass.\n2. Slightly increased small bilateral pleural effusions.\n3. Redemonstrated multiple bilateral pulmonary metastases.\n4. Severe aortic stenosis, coronary and mitral annulus calcification.\n5. For a full description of diagnostic findings reference is made to report\nof CT torso study done ___" + }, + { + "input": "At 10 o'clock 11 cm from the nipple is identified a 0.5 x 0.6 x 0.3 cm benign\nappearing intramammary lymph node. No other solid mass is seen. This\nintramammary node is felt to likely correspond to the mammographic finding on\nthe screening study dated ___. The patient may resume routine\nscreening.", + "output": "0.5 x 0.6 x 0.3 cm benign appearing intramammary lymph node corresponding to\nthe nodular mass in the upper posterior right breast on the MLO view of the\nrecent screening study dated ___. The patient may resume routine\nscreening.\n\nRECOMMENDATION: Annual screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the time of imaging.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the left lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 3.8 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ personally supervised the trainee during the key components of\nthe procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 3.8 L of fluid were removed and sent for requested analysis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 120 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 59, 75, and 108 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 26 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 57, 108, and 61 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.9.\nThe external carotid artery has peak systolic velocity of 101 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Unremarkable study. No evidence of carotid artery stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 91 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 147, 165, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 45 cm/sec.\nThe ICA/CCA ratio is 1.8.\nThe external carotid artery has peak systolic velocity of 145 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has heavy atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 111 cm/sec.\nThe left internal carotid artery is Doppler silent consistent with previously\nseen occlusion. .\n\nThe external carotid artery has peak systolic velocity of 158 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Left ICA occlusion as seen previously.\n60- 69% right ICA stenosis. Velocities ___ year ago were 138/50 in the right\nICA. This is not significantly changed and the degree of stenosis on the\nright may be overestimated due to the presence of contralateral occlusion." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 80 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 151, 92, and 92 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 40 cm/sec.\nThe ICA/CCA ratio is 1.9.\nThe external carotid artery has peak systolic velocity of 140 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left internal carotid artery is occluded.\nThe peak systolic velocity in the left common carotid artery is 63 cm/sec.\nThe external carotid artery has peak systolic velocity of 115 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "The left ICA is occluded, as was seen previously.\n\n60-69% stenosis of the right ICA, not significantly changed compared to\n___." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 72 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 152, 92, and 95 cm/sec, respectively.\nThe peak end diastolic velocity in the right internal carotid artery is 46\ncm/sec.\nThe ICA/CCA ratio is 2.1.\nThe external carotid artery has peak systolic velocity of 142 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has occlusive atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 50 cm/sec.\nThe left internal carotid artery is occluded. The external carotid artery has\npeak systolic velocity of 101 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Right ICA 60-69% stenosis.\nLeft ICA is occluded." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 87 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 150, 96, and 97 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 48 cm/sec.\nThe ICA/CCA ratio is 1.7.\nThe external carotid artery has peak systolic velocity of 157 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has atherosclerotic plaque, which occludes the\nleft internal carotid artery.\nThe peak systolic velocity in the left common carotid artery is 47 cm/sec.\nThe external carotid artery has peak systolic velocity of 116 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Left internal carotid artery occlusion and 60-69% stenosis of the right\ninternal carotid artery, not appreciably changed from prior ___\nexam." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 76 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 749, 89, and 73 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 32 cm/sec.\nThe ICA/CCA ratio is 1.9.\nThe external carotid artery has peak systolic velocity of 210 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nRe-demonstrated left internal carotid artery occlusion.\nThe left carotid vasculature has severe atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 82 cm/sec.\nThe external carotid artery has peak systolic velocity of 172 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "50-69% stenosis of the right internal carotid artery.\n\nRe-demonstrated left internal carotid artery occlusion." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe heterogeneous plaque atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 102 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 86 cm/s, 165 cm/s, and 104 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 47 cm/sec.\nThe ICA/CCA ratio is 1.6.\nThe external carotid artery has peak systolic velocity of134 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has severe heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 70 cm/s.\nThe left internal carotid artery is occluded.\nThe external carotid artery has peak systolic velocity of 118 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Interval worsening of the right internal carotid stenosis common now 60-69%\nstenosis.\nRe-demonstrated complete occlusion of the left internal carotid artery." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n100 cm/sec in its proximal portion, 138 cm/sec in its mid portion, and 74\ncm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of 78\ncm/sec.\nThe external carotid artery has peak systolic velocity of 119 cm/sec.\nThe vertebral artery has peak systolic velocity of 54 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.8.\n\nLEFT:\nThe left carotid vasculature has severe atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of 0\ncm/sec in its proximal portion, 0 cm/sec in its mid portion, and 0 cm/sec in\nits distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 56\ncm/sec.\nThe external carotid artery has peak systolic velocity of 120 cm/sec.\nThe vertebral artery has peak systolic velocity of 68 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is occluded.", + "output": "Patent right carotid system with 40-59 percent ICA stenosis. The left internal\ncarotid artery is occluded. Bilateral vertebral artery flow is antegrade. \nThere is minimal change compared to the prior study of ___" + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications. Specimen was immediately taken to the pathology department\nfollowing our rush biopsy protocol.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 75 mcg fentanyl throughout the total intra-service time of 15\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy. Specimen was immediately taken to\nthe pathology department following our rush biopsy protocol." + }, + { + "input": "Distended gallbladder with noted indwelling biliary sludge is again noted.", + "output": "Successful ultrasound-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation.\n\nRECOMMENDATION(S): See POE for drain care recommendations." + }, + { + "input": "Two small hypoechoic rounded collections/foci within the intradermal soft\ntissues of the right breast at the 4 o'clock position, measure 0.4 x 0.3 x 0.5\ncm and 1.8 x 0.3 x 2.1 cm, respectively.\n\nNo additional lesions identified.", + "output": "Two tiny intradermal abscesses or focal areas of induration at the site\npalpable abnormality, too small to drain.\n\nRECOMMENDATION(S): Nonemergent follow-up with the breast clinic.\n\nTwo tiny intradermal abscesses or focal areas of induration \nat the site palpable abnormality, too small to drain. Nonemergent follow-up\nwith the breast clinic is suggested." + }, + { + "input": "In the right breast at 12 o'clock approximately 1 cm from the nipple there is\na well-circumscribed, anechoic mass measuring 3.3 x 1.7 x 2.9 cm with mild\nposterior acoustic enhancement. The surrounding subcutaneous tissues are\nechogenic and mildly hyperemic.\n\nIn the right breast at 6 o'clock approximately 1 cm from the nipple, there is\na second well-circumscribed, anechoic oval parallel mass measuring 1.9 x 1.5 x\n2.5 cm with posterior acoustic enhancement.", + "output": "1. 3.3 x 1.7 x 2.9 cm cyst in the right slightly upper breast with\nsurrounding edema, suspicious for infection.\n2. 1.9 x 1.5 x 2.5 cm cyst in the right slightly lower breast.\n\nRECOMMENDATION(S): Ultrasound-guided cyst aspiration/drainage.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Targeted ultrasound of the right breast was performed. Re-demonstrated are 2\nanechoic cysts in the retroareolar right breast located at 12 o'clock and 6\no'clock, both approximately 1 cm from the nipple. Echogenic soft tissue is\nnoted surrounding the more superior cyst located at 12 o'clock.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___. ___ M.D. and ___, N.P. and ___, M.D.\n(Attending).\n\nDescription:\nUsing ultrasound guidance, aseptic technique and 1% lidocaine for local\nanesthesia, an 18 gauge needle was placed into the lesion located at 6\no'clock. Approximately 3 cc of the yellow-brown, clear fluid was aspirated. \nThe fluid was discarded due to lack of suspicion.\n\nUsing ultrasound guidance, aseptic technique and 1% lidocaine for local\nanesthesia, an 18 gauge needle was placed into the lesion located at 12\no'clock. Approximately 5 cc of purulent yellow fluid was aspirated. The\nfluid was sent to microbiology.\n\nEstimated blood loss: < 1 cc.\nSpecimens: sent to microbiology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Aspirated breast cysts.\nStandard post care instructions were provided to the patient.", + "output": "Technically successful US-guided aspiration of the right breast cysts.\n\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation.\n\nRECOMMENDATION(S): Clinical follow-up. Annual mammography." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThe asymmetry in the lower inner right breast is re- demonstrated on\nadditional imaging performed today. It measures up to 1.6 cm. This was\nfurther evaluated with ultrasound.\n\nRIGHT BREAST ULTRASOUND: In the right breast at 5 o'clock 3 cm from the\nnipple there is a 1.9 x 0.4 x 0.5 cm serpentine hypoechoic mass. There is no\ninternal vascularity. This correlates well with the mammographic finding. \nThis has the appearance of a dilated duct with internal material and may\nrepresent a benign entity such as papilloma or fibroadenoma.", + "output": "Right breast mass.\n\nRECOMMENDATION(S): Ultrasound-guided core biopsy is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. Findings were also communicated to Dr. ___ e-mail at the time\nof the exam.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "Targeted ultrasound of the right breast at 5 o'clock, 3 cm from the nipple was\nperformed and selected images were obtained. At 5 o'clock, 3 cm from the\nnipple, again seen is a 1.5 x 0.5 x 1.4 cm serpentine hypoechoic mass with no\ninternal vascularity.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, M.D.. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 7\ncores were obtained using a 12-gauge Celero vacuum-assisted biopsy device. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Targeted ultrasound of the right breast at 5 o'clock, 3 cm from the nipple was\nperformed and selected images were obtained. At 5 o'clock, 3 cm from the\nnipple, again seen is a 1.5 x 0.5 x 1.4 cm serpentine hypoechoic mass with no\ninternal vascularity.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___. ___, M.D.. The procedure was supervised by ___.\n___, M.D. (Attending).\n\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 7\ncores were obtained using a 12-gauge Celero vacuum-assisted biopsy device. \nNext, a percutaneous ribbon clip was deployed under ultrasound guidance. The\nneedle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from ___ in ___\nbusiness days. Standard post care instructions were provided to the patient.\n\nAs the Attending radiologist, I personally supervised the Resident during the\nkey components of the above procedure and I reviewed and agree with the\nResident's findings and dictation." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed. Multiple hypoechoic lesions were identified, as seen on prior\nultrasound. The lesion for biopsy was selected in the right lobe and a\nsuitable approach for targeted biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, two 18-gauge core biopsy samples were\nobtained and placed in formalin for pathologic analysis.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 75\nmg Versed and 1.5 mcg fentanyl throughout the total intra-service time of 12\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 2, with specimens sent to\npathology." + }, + { + "input": "There is normal respiratory variation in both common femoral veins. There is\nnormal compressibility and augmentation of both common femoral, superficial\nfemoral and popliteal veins. Normal compressibility and color flow are\ndemonstrated in the bilateral posterior tibial and peroneal veins.", + "output": "No evidence of deep vein thrombosis in either lower extremity." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe heterogeneous atherosclerotic plaque,\ngreatest in the CCA and proximal and mid ICA.\nThe peak systolic velocity in the right common carotid artery is 98 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 86 cm/s, 97 cm/s, and 103 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 22 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of84 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has severe heterogeneous atherosclerotic plaque,\ngreatest in the CCA and proximal, mid and distal ICA.\nThe peak systolic velocity in the left common carotid artery is 80 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 351 cm/s, 180 cm/s, and 146 cm/s respectively. The peak\nend diastolic velocity in the left internal carotid artery is 77 cm/sec.\nThe ICA/CCA ratio is 4.4.\nThe external carotid artery has peak systolic velocity of 138 cm/s.\nThe vertebral artery is patent with retrograde flow with complete reversal of\nflow. Of note, the patient has a new HD fistula in the left arm.", + "output": "70-79% stenosis in the left internal carotid artery.\n\nLess than 40% stenosis in the right internal carotid artery.\n\nRetrograde left vertebral artery flow consistent with subclavian steal\nsyndrome. Of note, the patient has a new HD fistula in the left upper\nextremity." + }, + { + "input": "RIGHT:\nThere is severe heterogenous, calcified atherosclerotic plaque in the right\ncarotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 80.9 cm/s / 11.1 cm/s\nCCA Distal: 73.9 cm/s / 15.8 cm/s\nICA ___: 36/7 cm/s / 15.8 cm/s\nICA Mid: 51/9 cm/s / 11.8 cm/s\nICA Distal: 75/15 cm/s / 11 cm/s\nECA: 62.3 cm/s\nVertebral: 47.3 cm/s\n\nICA/CCA Ratio: 1.0\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate homogenous atherosclerotic plaque in the left mid internal\ncarotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 75.6 cm/s / 11.1 cm/s\nCCA Distal: 114 cm/s / 12.3 cm/s\nICA ___: 129 cm/s / 18.7 cm/s\nICA Mid: 285 cm/s / 47.1 cm/s\nICA Distal: 127 cm/s / 23.6 cm/s\nECA: 128 cm/s\nVertebral: 108 cm/s\n\nICA/CCA Ratio: 2.5\n\nThe left vertebral artery flow is retrograde flow.", + "output": "Right ICA <40% stenosis.\nLeft ICA 70-79% stenosis (likely closer to 70% given relatively low ICA to CCA\nratio).\n\nWhen compared to ___, there has significantly decreased\natherosclerotic plaque in the proximal ICA and decrease in peak systolic\nvelocity within the proximal ICA s/p CEA." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\ntwo core biopsy samples were obtained and placed in separate containers for\nresearch. The skin was then cleaned and a dry sterile dressing was applied.\nThere were no immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of\n1.5 mg Versed and 75 mcg fentanyl throughout the total intra-service time of\n18 minutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy x 2 per clinical trial." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the right lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 500 cc of clear, straw-colored fluid\nSamples: None\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 500 cc of fluid were removed and, and 20 cc were sent for analysis." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight: There is a 2.8 x 1.7 x 2.1 cm area of architectural distortion in the\nright upper outer quadrant at middle to posterior depth. This was likely the\nbiopsied complex sclerosing lesion (___), however, there is no clip\nin the lesion. There are a few scattered benign calcifications seen in the\nright breast.\n\nLeft: There is a 1.3 cm mass in the lateral left breast along the mid nipple\nline (corresponding to the lesion at ___ o'clock). Another 1 cm mass is seen\nin the inferior left breast posterior depth, which likely corresponds to the\n1.2 cm mass is seen in the medial breast on the CC view. There are no\nassociated microcalcifications. The remainder of the left breast is\nunremarkable.\n\nBILATERAL BREAST ULTRASOUND:\nRight: Scanning of the right breast at ___ o'clock 5 cm from the nipple\ndemonstrates an irregular hypoechoic mass with architectural distortion\nmeasuring 1.5 x 1.0 x 1.2 cm. There is prominent vascularity to this lesion. \nThis finding likely represents the previously biopsied complex sclerosing\nlesion.\n\nLeft: Targeted ultrasound of the left breast at ___ o'clock 5-6 cm from the\nnipple demonstrates a 1.0 x 0.6 x 1.3 cm oval circumscribed hypoechoic mass\nwithout dominant vascularity or posterior shadowing.\nAt 7 o'clock 5 cm from the nipple there is a 1.2 x 0.6 x 1.1 cm oval\ncircumscribed hypoechoic mass without dominant vascularity or posterior\nshadowing, with an internal septation.\nAt 10 o'clock 4 cm from the nipple there is a 0.8 x 0.4 x 0.7 cm oval\nhypoechoic mass without dominant vascularity or posterior shadowing.\nAt 11 o'clock 4 cm from the nipple there is a 0.6 x 0.4 x 0.7 cm oval\nhypoechoic mass without dominant vascularity or posterior shadowing.", + "output": "Right: 2.8 x 1.7 x 2.1 cm area of architectural distortion in the right upper\nouter quadrant at middle to posterior depth. This corresponds to the\nultrasound lesion in the right breast at ___ o'clock 5 cm from the nipple\nwhich measures 1.5 x 1.0 x 1.2 cm. As this corresponds to the complex\nsclerosing lesion, excision is recommended.\n\nLeft: Probably benign left breast masses likely fibroadenoma. 3 of these were\npreviously documented (___) and were similar in size although 1-2 mm\ngreater for some size ___ today. The lesion at 11 o'clock however is\nnew. Six-month follow-up of the left breast with ultrasound is recommended.\n\nRECOMMENDATION(S): Right breast: Excision of the complex sclerosing lesion. \nIf re biopsy is necessary, please assist the patient in scheduling this as she\nwas not given a biopsy appointment today.\n\nLeft breast: Six-month follow-up left breast ultrasound.\n\nNOTIFICATION: Today's findings and recommendations were discussed in detail\nwith the patient with the assistance of a ___ interpreter, who also\nassisted with translation of the pathology report.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\n\nRight: There is a 2.8 x 1.7 x 2.1 cm area of architectural distortion in the\nright upper outer quadrant at middle to posterior depth. This was likely the\nbiopsied complex sclerosing lesion (___), however, there is no clip\nin the lesion. There are a few scattered benign calcifications seen in the\nright breast.\n\nLeft: There is a 1.3 cm mass in the lateral left breast along the mid nipple\nline (corresponding to the lesion at ___ o'clock). Another 1 cm mass is seen\nin the inferior left breast posterior depth, which likely corresponds to the\n1.2 cm mass is seen in the medial breast on the CC view. There are no\nassociated microcalcifications. The remainder of the left breast is\nunremarkable.\n\nBILATERAL BREAST ULTRASOUND:\nRight: Scanning of the right breast at ___ o'clock 5 cm from the nipple\ndemonstrates an irregular hypoechoic mass with architectural distortion\nmeasuring 1.5 x 1.0 x 1.2 cm. There is prominent vascularity to this lesion. \nThis finding likely represents the previously biopsied complex sclerosing\nlesion.\n\nLeft: Targeted ultrasound of the left breast at ___ o'clock 5-6 cm from the\nnipple demonstrates a 1.0 x 0.6 x 1.3 cm oval circumscribed hypoechoic mass\nwithout dominant vascularity or posterior shadowing.\nAt 7 o'clock 5 cm from the nipple there is a 1.2 x 0.6 x 1.1 cm oval\ncircumscribed hypoechoic mass without dominant vascularity or posterior\nshadowing, with an internal septation.\nAt 10 o'clock 4 cm from the nipple there is a 0.8 x 0.4 x 0.7 cm oval\nhypoechoic mass without dominant vascularity or posterior shadowing.\nAt 11 o'clock 4 cm from the nipple there is a 0.6 x 0.4 x 0.7 cm oval\nhypoechoic mass without dominant vascularity or posterior shadowing.", + "output": "Right: 2.8 x 1.7 x 2.1 cm area of architectural distortion in the right upper\nouter quadrant at middle to posterior depth. This corresponds to the\nultrasound lesion in the right breast at ___ o'clock 5 cm from the nipple\nwhich measures 1.5 x 1.0 x 1.2 cm. As this corresponds to the complex\nsclerosing lesion, excision is recommended.\n\nLeft: Probably benign left breast masses likely fibroadenoma. 3 of these were\npreviously documented (___) and were similar in size although 1-2 mm\ngreater for some size ___ today. The lesion at 11 o'clock however is\nnew. Six-month follow-up of the left breast with ultrasound is recommended.\n\nRECOMMENDATION(S): Right breast: Excision of the complex sclerosing lesion. \nIf re biopsy is necessary, please assist the patient in scheduling this as she\nwas not given a biopsy appointment today.\n\nLeft breast: Six-month follow-up left breast ultrasound.\n\nNOTIFICATION: Today's findings and recommendations were discussed in detail\nwith the patient with the assistance of a ___ interpreter, who also\nassisted with translation of the pathology report.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "Preprocedure targeted right breast ultrasound performed. At 10 o'clock 5 cm\nfrom nipple there is redemonstration of a hypoechoic area which appears\nsimilar to prior imaging and will be targeted for ultrasound-guided core\nbiopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.clinicians The procedure was supervised by ___.\n___, M.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 8\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views demonstrate expected post biopsy\nchanges and confirm appropriate clip placement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the BreastCare ___ provider with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Preprocedure targeted right breast ultrasound performed. At 10 o'clock 5 cm\nfrom nipple there is redemonstration of a hypoechoic area which appears\nsimilar to prior imaging and will be targeted for ultrasound-guided core\nbiopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, M.D.clinicians The procedure was supervised by ___.\n___, M.D.Attending.\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 8\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views demonstrate expected post biopsy\nchanges and confirm appropriate clip placement.", + "output": "Technically successful US-guided core biopsy of the right breast lesion.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the BreastCare ___ provider with the results and the appropriate\nrecommendations.\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Targeted ultrasound was performed of the left breast in the area of tenderness\nand palpable concern, as indicated by the patient. The left breast was\nscanned at 1 o'clock, 5-12 cm from the nipple, 2 o'clock, 9 cm from the\nnipple, and 3 o'clock, 7 cm from the nipple. No suspicious solid or cystic\nmass identified.", + "output": "No suspicious solid or cystic mass identified. No abnormal finding seen to\ncorrespond to the area of pain and palpable concern.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nFurther management of left breast pain/area of palpable concern, including any\ndecision for biopsy, should be based on the clinical assessment.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThere is mild heterogenous atherosclerotic plaque in the right carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 109 cm/s / 24.3 cm/s\nCCA Distal: 91.7 cm/s / 20 cm/s\nICA ___: 70.5 cm/s / 13.5 cm/s\nICA Mid: 98.1 cm/s / 32.2 cm/s\nICA Distal: 96.7 cm/s / 31.5 cm/s\nECA: 92.5 cm/s\nVertebral: 60.2 cm/s\n\nICA/CCA Ratio: 1.07\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is mild heterogenous atherosclerotic plaque in the left carotid artery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 90.4 cm/s / 18.2 cm/s\nCCA Distal: 76.4 cm/s / 15.5 cm/s\nICA ___: 68.6 cm/s / 15.9 cm/s\nICA Mid: 84.5 cm/s / 26.9 cm/s\nICA Distal: 103 cm/s / 32.2 cm/s\nECA: 82.3 cm/s\nVertebral: 25.8 cm/s\n\nICA/CCA Ratio: 1.35\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA <40% stenosis.\nLeft ICA <40% stenosis." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight: There are multiple indeterminate calcifications including\nmicrocalcifications in the upper, central-outer breast at middle depth which\nspan 2.4 x 1.6 x 0.4 cm.\nThere is another group of punctate calcifications and microcalcifications seen\nin the anterior right medial breast just above the mid nipple line. These are\nless concerning compared to the larger group.\nThere is no suspicious dominant mass.\nComparison to prior studies would provide additional information.\n\nLeft: There is diffuse skin thickening and prominence of the trabecular\npattern consistent with marked edema. There is no suspicious dominant mass or\nsuspicious grouped calcifications.\n\nBILATERAL BREAST ULTRASOUND:\nRight: Targeted ultrasound of the right upper central breast was performed\nwhich is without a discrete mass to target for ultrasound-guided core biopsy. \nLimited whole breast ultrasound was also performed and is unremarkable.\nLeft: Targeted ultrasound of the left breast demonstrates diffuse skin\nthickening measuring up to 1 cm with diffuse increased echogenicity of the\nbreast parenchyma consistent with diffuse edema. Limited whole breast\nultrasound is without a discrete mass target for biopsy.", + "output": "Right: Indeterminate calcifications in the upper central-outer breast at\nmiddle depth spanning 2.4 cm. If priors are not available in an appropriate\ntime interval, consideration could be given to stereotactic core biopsy. \nManagement of the second group would depend on pathology of the first group,\nas these are less concerning.\n\nLeft: Diffuse edema which is likely related to dependent edema.\n\nRECOMMENDATION(S): Comparison to prior imaging is recommended. In the\nabsence of prior imaging and/or to facilitate the patient's care,\nconsideration could be given to stereotactic core biopsy of the right breast\ncalcifications, however, the patient's coagulopathy would have to be corrected\nprior to stereotactic core biopsy.\n\nNOTIFICATION: The findings of indeterminate right breast calcifications were\ndiscussed with the patient and her husband (as well as the patient's daughter\nby phone). They agree to proceed as per her care team. Preliminary email was\nsent to her breast surgery care team.\n\nBI-RADS: 0 Incomplete - Need Prior Mammograms for \nComparison." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nRight: There are multiple indeterminate calcifications including\nmicrocalcifications in the upper, central-outer breast at middle depth which\nspan 2.4 x 1.6 x 0.4 cm.\nThere is another group of punctate calcifications and microcalcifications seen\nin the anterior right medial breast just above the mid nipple line. These are\nless concerning compared to the larger group.\nThere is no suspicious dominant mass.\nComparison to prior studies would provide additional information.\n\nLeft: There is diffuse skin thickening and prominence of the trabecular\npattern consistent with marked edema. There is no suspicious dominant mass or\nsuspicious grouped calcifications.\n\nBILATERAL BREAST ULTRASOUND:\nRight: Targeted ultrasound of the right upper central breast was performed\nwhich is without a discrete mass to target for ultrasound-guided core biopsy. \nLimited whole breast ultrasound was also performed and is unremarkable.\nLeft: Targeted ultrasound of the left breast demonstrates diffuse skin\nthickening measuring up to 1 cm with diffuse increased echogenicity of the\nbreast parenchyma consistent with diffuse edema. Limited whole breast\nultrasound is without a discrete mass target for biopsy.", + "output": "Right: Indeterminate calcifications in the upper central-outer breast at\nmiddle depth spanning 2.4 cm. If priors are not available in an appropriate\ntime interval, consideration could be given to stereotactic core biopsy. \nManagement of the second group would depend on pathology of the first group,\nas these are less concerning.\n\nLeft: Diffuse edema which is likely related to dependent edema.\n\nRECOMMENDATION(S): Comparison to prior imaging is recommended. In the\nabsence of prior imaging and/or to facilitate the patient's care,\nconsideration could be given to stereotactic core biopsy of the right breast\ncalcifications, however, the patient's coagulopathy would have to be corrected\nprior to stereotactic core biopsy.\n\nNOTIFICATION: The findings of indeterminate right breast calcifications were\ndiscussed with the patient and her husband (as well as the patient's daughter\nby phone). They agree to proceed as per her care team. Preliminary email was\nsent to her breast surgery care team.\n\nBI-RADS: 0 Incomplete - Need Prior Mammograms for \nComparison." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 8 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the right lobe\nof the liver and a single core biopsy sample was obtained and placed in\nformalin, and was sent directly to the pathology lab for rush technique. The\nskin was then cleaned and a dry sterile dressing was applied. There was no\nimmediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 24\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted transplant liver biopsy." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nSurgical clips are noted in the lower central right breast. Questioned\narchitectural distortion in the outer right breast is not re-demonstrated on\nthe spot compression or the rolled lateral view. There is a suggestion of\narchitectural distortion in the outer right breast on the rolled medial view. \nBased on its location on the rolled views, this area is located within the\nlower right breast and likely correlates with the surgical excision that took\nplace in ___.\n\nBREAST ULTRASOUND: The entire outer right breast was scanned with special\nattention paid to the lower outer right breast. An incidental cyst is noted\nat 8 o'clock 7 cm from the nipple measuring 0.4 cm. Scarring from prior\nsurgery was not well seen. No abnormalities were identified in the entire\nouter right breast.", + "output": "Questioned architectural distortion in the outer right breast correlates with\nrecent surgery.\n\nRECOMMENDATION(S): Return to screening mammography for which the patient is\ndue in one year. 3D imaging at that time is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the liver was\nperformed, demonstrating extensive liver metastases.. The lesion for biopsy\nwas identified in the right hepatic lobe. A suitable approach for targeted\nliver biopsy was determined.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine.\n\nUnder real-time ultrasound guidance, 3 18-gauge core biopsy passes were made. \nThe sample was placed in formalin.\n\nThe skin was then cleaned and a dry sterile dressing was applied. There were\nno immediate complications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 1\nmg Versed and 50 mcg fentanyl throughout the total intra-service time of 14\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated 18-gauge targeted liver biopsy x 3, with specimen sent to\npathology." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has severe homogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 83 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 258, 164, and 145 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 83 cm/sec.\nThe ICA/CCA ratio is 3.1.\nThe external carotid artery has peak systolic velocity of 528 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the left common carotid artery is 137 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 125, 116, and 96 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 41 cm/sec.\nThe ICA/CCA ratio is 0.91.\nThe external carotid artery has peak systolic velocity of 99 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Significant homogeneous atherosclerotic plaque in the right ICA resulting\nin 70-79% stenosis.\n\n2. Moderate heterogeneous atherosclerotic plaque resulting in 40-59% stenosis\nof the left ICA." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nBilateral intramammary lymph nodes are seen. No mass, suspicious\nmicrocalcifications, or unexplained architectural distortion is identified in\neither breast or in the area of clinical concern in the upper outer left\nbreast, as noted by the triangle pain marker. Increasing asymmetries in the\nupper outer aspect of both breast correlate with normal breast tissue, as\nconfirmed on 3D imaging.\n\nLEFT BREAST ULTRASOUND: There of clinical concern in the upper outer left\nbreast was scanned, as indicated by the patient. No abnormality is identified\nin this location.", + "output": "No evidence for malignancy.\n\nRECOMMENDATION(S): Clinical followup for the area of clinical concern in the\nleft breast. Age and risk appropriate screening mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "1. Preprocedure imaging was performed demonstrating the enlarged right\ninguinal lymph node corresponding to that seen on the most recent CT.\n2. 18 gauge core biopsy needle was used to obtain 6 core samples through the\nenlarged right inguinal node per lymphoma protocol.\n3. No immediate postprocedural complications.", + "output": "1. Technically successful ultrasound-guided right inguinal lymph node core\nbiopsy." + }, + { + "input": "Ultrasound examination demonstrated 2 adjacent right inguinal lymph nodes. \nThe larger, superiorly located 3.0 x 2.1 x 2.5 cm node was selected for\nbiopsy. Samples appeared satisfactory.", + "output": "Technically successful ultrasound-guided right inguinal lymph node biopsy,\nwith samples sent for pathology (in RPMI and formalin) and research in\nresearch media." + }, + { + "input": "The liver shows coarsened echotexture and a nodular contour, in keeping with\nknown cirrhosis. No focal hepatic lesions are identified. There is no evidence\nof intrahepatic or extrahepatic biliary dilatation. The gallbladder has been\nsurgically removed and the common bile duct again measures up to 1 cm. The\nmain portal vein is patent and demonstrates hepatopetal flow. Evaluation of\nthe pancreas is limited by overlying bowel gas, however visualized portions of\nthe pancreatic body are grossly normal. The spleen is enlarged measuring 17 cm\nand has homogenous echotexture. There is redemonstration of a 7.3 x 6.2 x 6.5\ncm simple cyst in the mid portion of the right kidney. Representative image of\nthe left kidney is normal. The right kidney measures 11 cm and left kidney\nmeasures 9.5 cm. There is small amount of perihepatic fluid. There is no free\nfluid within the left or right lower quadrants. There is a new patent\numbilical vein.", + "output": "1. Cirrhotic liver with no suspicious focal hepatic lesions. Splenomegaly, in\nkeeping with sequela of portal hypertension.\n2. Small amount of perihepatic ascites.\n3. Simple appearing cyst in the right kidney, slightly increased in size since\nprior examination.\n4. New patent umbilical vein." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 15\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "Limited preprocedure grayscale and Doppler ultrasound imaging of the right\nhepatic lobe was performed and a suitable approach for non targeted liver\nbiopsy was determined. No other abnormalities were identified on the limited\nimaging.\n\nTECHNIQUE: The risks, benefits, and alternatives of the procedure were\nexplained to the patient. After a detailed discussion, informed written\nconsent was obtained. A pre-procedure timeout using three patient identifiers\nwas performed per ___ protocol.\n\nBased on the preprocedure imaging, an appropriate skin entry site for the\nbiopsy was chosen. The site was marked. The skin was then prepped and draped\nin the usual sterile fashion. The superficial soft tissues to the liver\ncapsule were anesthetized with 10 mL 1% lidocaine. Under real-time ultrasound\nguidance, an 18 gauge core biopsy needle was then advanced into the liver and\na single core biopsy sample was obtained and placed in formalin. The skin was\nthen cleaned and a dry sterile dressing was applied. There was no immediate\ncomplications.\n\nSEDATION: Moderate sedation was provided by administering divided doses of 2\nmg Versed and 100 mcg fentanyl throughout the total intra-service time of 18\nminutes during which patient's hemodynamic parameters were continuously\nmonitored by an independent trained radiology nurse.", + "output": "Uncomplicated non-targeted liver biopsy." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe right common carotid artery had peak systolic/diastolic velocities of\n66/22 cm/sec.\nThe right internal carotid artery had peak systolic/diastolic velocities of\n81/34 cm/sec in its proximal portion, 89/30 cm/sec in its mid portion and\n92/32 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 74cm/sec.\nThe vertebral artery has peak systolic velocity of 41 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.3..\n\nLEFT:\nThe leftcarotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe left common carotid artery had peak systolic/diastolic velocities of 78/24\ncm/sec.\nThe left internal carotid artery had peaks ystolic/diastolic velocities of\n55/22 cm/sec in its proximal portion, 63/26 cm/sec in its mid portion and\n74/28 cm/sec in its distal portion.\nThe external carotid artery has peak systolic velocity of 127cm/sec.\nThe vertebral artery has peak systolic velocity of 76 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.94.", + "output": "Less than 40% stenosis in the bilateral internal carotid arteries." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n60/14 cm/sec in its proximal portion, 65/23 cm/sec in its mid portion, and\n72/23 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n91/21 cm/sec.\nThe external carotid artery has peak systolic velocity of 45/9 cm/sec.\nThe vertebral artery has peak systolic velocity of 46 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 0.79.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n57/19 cm/sec in its proximal portion, 65/24 cm/sec in its mid portion, and\n59/26 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of\n116/23 cm/sec.\nThe external carotid artery has peak systolic velocity of 47 cm/sec.\nThe vertebral artery has peak systolic velocity of 63 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 0.56.", + "output": "No hemodynamically significant carotid stenosis. Mild atherosclerotic plaque." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe right internal carotid artery has peak systolic/diastolic velocities of\n51/9 cm/sec in its proximal portion, 71/14 cm/sec in its mid portion, and\n59/14 cm/sec in its distal portion.\nThe right common carotid artery has peak systolic/diastolic velocities of\n71/11 cm/sec.\nThe external carotid artery has peak systolic velocity of 144 cm/sec.\nThe vertebral artery has peak systolic velocity of 43 cm/sec with normal\nantegrade flow.\nThe right ICA/CCA ratio is 1.0.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe left internal carotid artery has peak systolic/diastolic velocities of\n54/10 cm/sec in its proximal portion, 62/14 cm/sec in its mid portion, and\n54/11 cm/sec in its distal portion.\nThe left common carotid artery has peak systolic/diastolic velocities of 62/11\ncm/sec.\nThe external carotid artery has peak systolic velocity of 92 cm/sec.\nThe vertebral artery has peak systolic velocity of 42 cm/sec with normal\nantegrade flow.\nThe left ICA/CCA ratio is 1.0.", + "output": "Less than 40% internal carotid artery stenosis bilaterally." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBREAST ULTRASOUND: The entire lower breast was scanned to evaluate the area\nof clinical concern. No abnormalities are present.", + "output": "No evidence for malignancy in either breast.\n\nRECOMMENDATION(S): Clinical follow-up for left breast lump. Age and risk\nappropriate screening.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a small\namount of ascites. A suitable target in the deepest pocket in the left upper\nquadrant was selected for paracentesis.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient's daughter over the telephone, and informed consent was\nobtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nA 5 ___ catheter was advanced into the largest fluid pocket in the left\nupper quadrant and 16 cc of clear, straw-colored fluid were removed. Fluid\nsamples were submitted to the laboratory for cell count, differential, and\nculture.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic paracentesis.\n2. 16 cc of fluid were removed and sent for analysis." + }, + { + "input": "Targeted ultrasound of the right upper inner quadrant was performed from 12\no'clock through 3 o'clock demonstrating normal heterogeneously dense\nparenchyma without an underlying suspicious solid or cystic mass. In\nparticular, there is no abnormality at 2 o'clock.", + "output": "No specific evidence of malignancy on this targeted ultrasound.\n\nRECOMMENDATION(S): Clinical follow-up for right breast pain.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 91 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 128, 93, and 60 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.4.\nThe external carotid artery has peak systolic velocity of 102 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 90 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 54, 75, and 81 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.90.\nThe external carotid artery has peak systolic velocity of 101 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Moderate heterogeneous atherosclerotic plaque in the right ICA resulting\nin elevated velocities in the proximal right internal carotid artery which\napproaches sonographic criteria for moderate stenosis based on the peak\nsystolic velocity (128 centimeters/second). Cross-sectional imaging may be\nperformed if further evaluation is desired.\n2. Mild heterogeneous atherosclerotic plaque in the left ICA resulting in\nless than 40% stenosis." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 111 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 76, 73, and 64 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 130 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 109 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 62, 70, and 51 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 0.7.\nThe external carotid artery has peak systolic velocity of 95 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild (less than 40%) stenosis of the bilateral internal carotid arteries." + }, + { + "input": "The spleen measures 9.4 cm in AP dimension. Throughout essentially the entire\nspleen, there are numerous near completely anechoic lesions, many\nwell-circumscribed, which measure up to 1.6 cm within the anterior inferior\nspleen. Additionally, several of these lesions demonstrate central\nechogenicity in a bull's eye/targetoid appearance. No definite internal flow\nis seen within the visualized lesions. The tip of the left hepatic lobe\ndrapes over the spleen. There is a small to moderate left pleural effusion.", + "output": "1. Numerous splenic lesions measuring up to 1.6 cm, which in the current\nclinical setting most likely represent abscesses (fungal or bacterial). \nAspiration would likely need to be performed with CT and concurrent ultrasound\nguidance.\n2. Small to moderate left pleural effusion." + }, + { + "input": "LEFT BREAST ULTRASOUND: Targeted ultrasound left breast was performed. In the\nleft breast at 3 o'clock 6 cm from the nipple is a well-circumscribed oval\nhypoechoic mass measuring 2.4 by 0.8 x 1.8 cm the shows some peripheral\nvascularity and posterior acoustic enhancement. This is stable compared to the\nprevious ultrasound of ___ given for differences in technique. A 1.7 cm\nsimple cyst with septation is noted in the vicinity at 3 o'clock 5 cm from the\nnipple.", + "output": "Probable benign mass in the left breast stable for 6 months and likely\nrepresents a fibroadenoma. Patient undergoing IVF treatment and would\ntherefore prefer definitive diagnosis, hence ultrasound-guided biopsy will be\nscheduled by the patient.\n\n\n\n BI-RADS: 3 Probably Benign." + }, + { + "input": "2.4 cm oval circumscribed left breast mass at 3 o'clock, likely a\nfibroadenoma. The patient is attempting to get pregnant and desires definitive\npathology.\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained. The patient\nrefused percutaneous clip placement.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: ___, M.D..\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 13-gaugecoaxial needle was placed adjacent to the lesion\nand using a 14-gauge Bard spring-loaded biopsy device, 5 cores were obtained.\nThe needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\nPOST-PROCEDURE MAMMOGRAM: Deferred, as no clip was placed.", + "output": "Technically successful US-guided core biopsy of the left breast lesion. \nPathology is pending.\n\nThe patient expects to hear the pathology results from the referring provider\n___ ___ business days. Standard post care instructions were provided to the\npatient." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has diffuse heterogeneous atherosclerotic\nplaque.\nThe peak systolic velocity in the right common carotid artery is 93 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 94, 88, and 72 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 294 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has diffuse heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 152 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 92, 64, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 20 cm/sec.\nThe ICA/CCA ratio is 0.6.\nThe external carotid artery has peak systolic velocity of 140 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Less than 40% stenosis of the right ICA.\n\nLess than 40% stenosis of the left ICA.\n\nOf note, there is 60-69% stenosis of the left CCA." + }, + { + "input": "Omental masses.", + "output": "Ultrasound-guided omental biopsy. Cytology is pending." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nTissue density: B - There are scattered areas of fibroglandular density\nThis is circumscribed oval mass in the right upper outer quadrant which on\nsame day ultrasound corresponds to a simple cyst. There is no other dominant\nmass, unexplained architectural distortion or suspicious grouped\nmicrocalcifications.\n\nBILATERAL BREAST ULTRASOUND:\n\nRight breast: Targeted ultrasound of the upper outer quadrant was performed.\nIn the 9 o'clock, 5 cm from the nipple there is a 0.4 x 0.2 x 0.4 cm anechoic\ncircumscribed oval mass with good through transmission and no internal\nvascularity. This is consistent with a simple cyst and corresponds to the\nmammographic abnormality.\n\nLeft breast: Ultrasound of the left breast at the area of clinical concern\nparticularly in the 2 o'clock 2 cm from the nipple demonstrates normal breast\nparenchyma. No solid or cystic mass is seen.", + "output": "No evidence of malignancy. No abnormality identified in the left breast at\nthe site of clinical concern.\n\nRECOMMENDATION: Final disposition of patient's symptoms should be based on\nclinical grounds. Otherwise Age and risk appropriate screening is recommended.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no new suspicious mass, architectural distortion or suspicious\ngrouped microcalcifications. An asymmetry in the lower posterior right breast\npersists on spot compression views, however on 3D images appears to represent\nnormal superimposed breast tissue. This asymmetry is unchanged since ___.\n\nBREAST ULTRASOUND: Ultrasound of the entire lower right breast was performed.\nMultiple cysts were seen, including a 7 mm cyst at 8 o'clock position 4 cm\nfrom the nipple, and a 3 mm cyst 4 o'clock position 5 cm from nipple. No\nsuspicious cystic or solid masses are seen.", + "output": "There is a probably benign asymmetry in the lower posterior right breast with\nno definite sonographic correlate, although it may represent 1 of the simple\ncysts seen on ultrasound. This asymmetry is unchanged since ___.\n\nRECOMMENDATION(S): Diagnostic mammogram of the right breast in ___ year is\nrecommended to document ___ year stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is no new suspicious mass, architectural distortion or suspicious\ngrouped microcalcifications. An asymmetry in the lower posterior right breast\npersists on spot compression views, however on 3D images appears to represent\nnormal superimposed breast tissue. This asymmetry is unchanged since ___.\n\nBREAST ULTRASOUND: Ultrasound of the entire lower right breast was performed.\nMultiple cysts were seen, including a 7 mm cyst at 8 o'clock position 4 cm\nfrom the nipple, and a 3 mm cyst 4 o'clock position 5 cm from nipple. No\nsuspicious cystic or solid masses are seen.", + "output": "There is a probably benign asymmetry in the lower posterior right breast with\nno definite sonographic correlate, although it may represent 1 of the simple\ncysts seen on ultrasound. This asymmetry is unchanged since ___.\n\nRECOMMENDATION(S): Diagnostic mammogram of the right breast in ___ year is\nrecommended to document ___ year stability.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "A total of 270 cc of serosanguineous fluid with significant debris was removed\nfrom the right lower quadrant drain by the time the patient left the\ndepartment.\n\nA total of 35 cc of yellow fluid with significant debris, likely purulent, was\nremoved on the midline lower abdomen drain by the time the patient left the\ndepartment.\n\nA total of 25 cc of clear yellow fluid, likely serous, was removed from the\nleft mid abdomen drain by the time the patient left the department.\n\nThe first 20 cc of fluid removed from each site was sent separately to the lab\nfor microbiology analysis (individually labeled as to site).", + "output": "Successful US-guided placement of ___ pigtail catheters into a right\nlower quadrant collection, a midline lower abdomen collection, and a left mid\nabdomen collection. Samples were sent for microbiology evaluation." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nPreviously described asymmetry seen in the upper right breast is not\nreproduced additional images and likely reflects superimposed fibroglandular\ntissue, and this area was further evaluated with ultrasound.\nAdditional imaging of the previously described asymmetry within the inner\nright breast demonstrates a possible 9 mm mass within the inner central breast\nposterior depth which was further evaluated with ultrasound.\nThere is no unexplained architectural distortion, or suspicious grouped\nmicrocalcifications.\n\nRIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed from\n11 o'clock through 3 o'clock, 2-10 cm from the nipple.\nNo suspicious mass or significant correlative ultrasound finding is seen\ncorresponding to mammographic asymmetry within the superior breast.\nAt 3 o'clock, 3 cm from the nipple, there is a benign simple cyst measuring\n0.7 x 0.3 x 0.8 cm which correlates with the mammographic asymmetry within the\ninner breast. Additional benign simple cyst visualized at 3 o'clock, 1 cm\nfrom nipple measuring 0.7 x 0.4 x 0.7 cm.", + "output": "1. No mammographic evidence of malignancy within the right breast. Inner\nright breast asymmetry corresponds to an 8 mm simple cyst on ultrasound and is\nbenign. Superior right breast asymmetry is not reproduced on additional\nmammographic or sonographic imaging and is compatible with superimposed normal\nbreast tissue.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThere is a biopsy clip in the lateral subareolar left breast, corresponding to\nsite of biopsy-proven malignancy. There is no discrete suspicious mass,\narchitectural distortion or suspicious grouped microcalcifications. There are\nstable coarse calcifications in the lateral subareolar left breast adjacent to\nthe biopsy clip.\n\nBREAST ULTRASOUND: At the 3 o'clock position of the left breast 1 cm from the\nnipple, there is an irregular hypoechoic mass with internal biopsy clip and\ncalcifications measuring approximately 1.8 x 0.9 x 1.2 cm. The mass is not\nsignificantly changed in appearance or size in comparison to the prior study\nallowing for differences in measuring technique. There is no new suspicious\nsolid or cystic mass.", + "output": "Biopsy-proven malignancy in the left breast, as above, which is not\nsignificantly changed in comparison to prior ultrasound allowing for\ndifferences in measuring technique. Biopsy clip within the mass. The mass is\namenable to needle localization via mammographic or sonographic approach.\n\nRECOMMENDATION(S): Appropriate action should be taken. The patient is\nscheduled to follow-up with Dr. ___ in ___ for surgical planning.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient and\nher son who agrees with the plan. Findings recommendations were reviewed with\nNP ___ at the time of imaging by telephone with confirmation.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "The 1.8 x 1.1 x 1.4 cm hypoechoic mass containing a clip and calcifications\nwas identified at 3 o'clock 1 cm from the nipple and was targeted for\nultrasound guided wire localization\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained. The patient's\nallergies and medications were reviewed. A pre-procedure time-out was\nperformed using three patient identifiers, with confirmation of side and site.\n\nThe patient's left breast was scanned and the mass and clip were identified. \nUsing standard aseptic technique, and ___ cc of 1% lidocaine for local\nanesthesia, a localizing needle and subsequently a wire were placed through\nthe lesion under ultrasound guidance from the inferior approach. The target\nis located between the distal stiffener and the tip of the wire.\n\nUNILATERAL DIGITAL POST-PROCEDURE MAMMOGRAM: Post procedure mammogram shows a\nlocalizing wire in the left breast.\nThe target is located along thedistal stiffener to the tip of the wire.\n\nThe patient tolerated the procedure well. There were no immediate\ncomplications. She was sent to the operating room with printed, annotated\nimages.\nThe procedure was supervised by Dr. ___ (Attending).", + "output": "Technically successful ultrasound wire localization of clip and mass in the\nleft breast.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Views of all 4 quadrants demonstrate no ascites. Paracentesis was therefore\ncanceled.", + "output": "No ascites seen. Paracentesis was therefore canceled.\n\nNOTIFICATION: Findings discussed with Dr. ___ by Dr. ___ the\ntelephone on ___ at 11:00, 5 min after they were made." + }, + { + "input": "Tissue density: A- The breast tissues are predominantly fatty with minimal\nresidual cyst fibroglandular tissue. The nodular asymmetry in the inner left\nbreast appear to persist at least on some of the imaging although the\nasymmetries were less apparent on the projection. There are no associated\nmicrocalcifications.\n\nUltrasound of the left breast from ___ o'clock 1-12 cm from the nipple in the\narea of concern on mammography was performed. At 8 o'clock 9 cm from the\nnipple is identified a 0.6 x 0.8 x 0.2 cm cystic appearing mass with the\nlargest cyst measuring 0.3 cm. The imaging appearance favors a benign process\nsuch as apocrine metaplasia and this possibly corresponds to the mammographic\nfinding. Six-month follow-up mammography and ultrasound of the left breast\nseems the most reasonable approach at this time.", + "output": "0.6 x 0.8 x 0.2 cm probable benign mass in the left breast at 8 o'clock\nfavoring apocrine metaplasia and possibly accounting for the finding on\nmammography. Six-month follow-up left diagnostic mammogram and ultrasound is\nrecommended at this time.\n\nRECOMMENDATION: Left diagnostic mammogram and ultrasound in six months.\n\nNOTIFICATION: Findings discussed with the patient at the time of imaging.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nThere is a 0.6 cm oval asymmetry in the inner left breast which is similar in\nappearance to the prior exam, without associated calcifications. There is no\nsuspicious dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed at 8:00 position, 9\ncm from the nipple. At this location there is a 0.7 x 0.2 x 0.5 cm oval\ncircumscribed hypoechoic mass with a portion which is anechoic, which is\nsmaller in comparison to the prior exam. The largest cystic component\nmeasures approximately 2 mm.", + "output": "Probably benign 0.7 cm mass in the left breast demonstrates six-month\nstability.\n\nRECOMMENDATION(S): Six-month follow-up left breast diagnostic mammogram and\nultrasound is recommended. At that time the patient will be due for her\nannual right breast mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\nThere is a 0.6 cm oval asymmetry in the inner left breast which is similar in\nappearance to the prior exam, without associated calcifications. There is no\nsuspicious dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted ultrasound was performed at 8:00 position, 9\ncm from the nipple. At this location there is a 0.7 x 0.2 x 0.5 cm oval\ncircumscribed hypoechoic mass with a portion which is anechoic, which is\nsmaller in comparison to the prior exam. The largest cystic component\nmeasures approximately 2 mm.", + "output": "Probably benign 0.7 cm mass in the left breast demonstrates six-month\nstability.\n\nRECOMMENDATION(S): Six-month follow-up left breast diagnostic mammogram and\nultrasound is recommended. At that time the patient will be due for her\nannual right breast mammogram.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan. She was given information to schedule her follow-up.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n5 mm well-circumscribed nodules in the left medial inferior breast remain\nstable. There are no spiculated masses suspicious grouped microcalcifications\nor areas of architectural distortion.\n\nBREAST ULTRASOUND: Targeted ultrasound left breast was performed. In the left\nbreast at 8 o'clock 9 cm from the nipple is a oval hypoechoic mass measuring\n0.6 x 0.2 by 0.5 cm with posterior acoustic enhancement and no vascularity.", + "output": "Stable probably benign mass in the left breast at 8 o'clock likely apocrine\nmetaplasia. Given stability for ___ year months a followup ultrasound is\nrecommended in ___ year at which time patient is due for bilateral mammography.\n\nRECOMMENDATION(S): Bilateral mammography and left breast ultrasound in ___\nyear.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nRight breast:\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nLeft breast:\n5 mm circumscribed mass in the lower inner breast middle depth is stable\nmammographically dating back to at least ___, consistent with a benign\nprocess. There is no suspicious dominant mass, unexplained architectural\ndistortion, or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted left breast ultrasound was performed. At 8\no'clock, 9 cm from nipple there is a circumscribed hypoechoic mass measuring\n0.6 x 0.2 x 0.5 cm without dominant vascularity or posterior acoustic\nshadowing. This is stable/less conspicuous compared to ___, consistent\nwith a benign process", + "output": "1. ___ year stability of a left breast mass on ultrasound and mammography,\nconsistent with a benign process.\n2. No mammographic specific evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nRight breast:\nThere is no suspicious dominant mass, unexplained architectural distortion or\nsuspicious grouped calcifications.\n\nLeft breast:\n5 mm circumscribed mass in the lower inner breast middle depth is stable\nmammographically dating back to at least ___, consistent with a benign\nprocess. There is no suspicious dominant mass, unexplained architectural\ndistortion, or suspicious grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted left breast ultrasound was performed. At 8\no'clock, 9 cm from nipple there is a circumscribed hypoechoic mass measuring\n0.6 x 0.2 x 0.5 cm without dominant vascularity or posterior acoustic\nshadowing. This is stable/less conspicuous compared to ___, consistent\nwith a benign process", + "output": "1. ___ year stability of a left breast mass on ultrasound and mammography,\nconsistent with a benign process.\n2. No mammographic specific evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Elongated and tortuous fluid collection in the pelvis targeted for drainage. \nAt conclusion of aspiration, no significant residual fluid seen.", + "output": "Successful US-guided drainage of a right hydrosalpinx. Samples were sent for\nmicrobiology and cytology evaluation." + }, + { + "input": "There is triphasic Doppler waveform in the subclavian, axillary, brachial, and\nulnar arteries. The peak systolic velocities range between 51 and 67 cm per\nsecond.\n\nThe proximal radial artery shows triphasic waveform with a peak systolic\nvelocity of 51 cm/sec. However there is diminished flow in the mid and distal\nradial artery with biphasic waveform and velocities ranging between 21 cm/sec\nand 28 cm/sec.", + "output": "Patent but diminished flow in the mid and distal radial artery with biphasic\nwaveform and velocities ranging between 21 cm/sec and 28 cm/sec. The remaining\nleft upper extremity arteries are within normal limits." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 69 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 67, 71, and 60 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 23 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 104 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild heterogeneous atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 82 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 65, 81, and 65 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 91 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "Mild atherosclerosis of the bilateral extracranial internal carotid arteries\nwithout significant stenosis (less than 40%)" + }, + { + "input": "Exophytic solid hypoechoic lower pole right renal mass measuring 13 x 14 mm,\nwhich was targeted for biopsy.", + "output": "Technically successful biopsy of right-sided renal mass. 3 specimens (18\ngauge 22 mm cores) were submitted for pathology. No immediate postprocedure\ncomplication." + }, + { + "input": "RIGHT:\nThere is moderate heterogenous atherosclerotic plaque in the right carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 103 cm/s / 17 cm/s\nCCA Distal: 68 cm/s / 11.1 cm/s\nICA ___: 60.4 cm/s / 15.8 cm/s\nICA Mid: 215 cm/s / 62.9 cm/s\nICA Distal: 113 cm/s / 34 cm/s mild delayed upstroke\nECA: 137 cm/s\nVertebral: 68 cm/s\n\nICA/CCA Ratio: 3.16\n\nThe right vertebral artery flow is antegrade with a normal spectral waveform.\n\n\nLEFT:\nThere is moderate heterogenous atherosclerotic plaque in the left carotid\nartery.\n\nSegment: PSV (cm/s) / EDV (cm/s)\n----------------------------------------------\nCCA ___: 149 cm/s / 22.3 cm/s\nCCA Distal: 113 cm/s / 19.6 cm/s\nICA ___: 84.1 cm/s / 18.1 cm/s\nICA Mid: 140 cm/s / 38 cm/s\nICA Distal: 106 cm/s / 28.7 cm/s\nECA: 136 cm/s\nVertebral: 77.3 cm/s\n\n\nICA/CCA Ratio: 1.24\n\nThe left vertebral artery flow is antegrade with a normal spectral waveform.", + "output": "Right ICA 60-69 % stenosis; however, slight delayed upstroke in distal ICA\nsuggests possible more severe stenosis in the mid ICA than appreciated by\nvelocity alone.\nLeft ICA 40-59% stenosis.\n\nRECOMMENDATION(S): Consider cross-sectional imaging to further delineate\nseverity of stenosis of right ICA if clinically indicated." + }, + { + "input": "Tissue density: C - The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe asymmetry in the left slightly inferior outer mid breast is pliable on\nspot compression views and no discrete mass seen on the 3D tomosynthesis\nimages obtained. Ultrasound was performed for further evaluation. The\nasymmetry in the left inferior posterior breast remain stable since ___.\n\nBREAST ULTRASOUND: Targeted ultrasound left breast was performed. The\ninferior outer breast was scanned. Few subcentimeter anechoic lesions\nconsistent with cyst/ focally dilated duct noted in the left breast at 4\no'clock 2-3 cm from the nipple. No discrete solid mass was noted.", + "output": "No evidence of malignancy. The asymmetry in the left inferior outer breast\nappears consistent with summation of shadows. Incidental cyst/focally dilated\nduct noted at 4 o'clock.\n\nRECOMMENDATION(S): Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Left breast ultrasound:\n\nTargeted ultrasound ___ o'clock left breast 3-5 cm from the nipple deep to the\nsurgical scar again demonstrates a complex fluid collection compatible with a\npostoperative seroma. On today's examination this collection measures 4.5 x\n6.5 x 1.4 cm which appears slightly larger when compared to post aspiration\nimage from ___.\n\nRight breast ultrasound:\n\nTargeted ultrasound 3 o'clock right breast 5-8 cm from the nipple at site of\npatient's discomfort demonstrates a similar appearing complex fluid collection\ndeep to the surgical scar measuring 2.1 x 3.0 x 0.5 cm consistent with a\npostoperative seroma.", + "output": "1. Residual/recurrence 4.5 x 6.5 x 1.4 cm complex fluid collection within the\nleft breast deep to surgical scar consistent with a postoperative seroma. \nSuperimposed infection cannot be entirely excluded. The patient is scheduled\nfor same day ultrasound-guided aspiration.\n2. Similar appearing but smaller 2.1 x 3.0 x 0.5 cm collection in the right\nbreast deep to the surgical scar consistent with a postoperative seroma. \nSuperimposed infection cannot be excluded. If patient's symptoms persist or\nworsen, this collection is amenable to ultrasound-guided aspiration as\nclinically indicated.\n\nRECOMMENDATION(S): 1. Ultrasound-guided aspiration left breast as requested\nby the ordering provider. 2. Clinical follow-up of the right breast.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 2 Benign." + }, + { + "input": "Distended gallbladder with focal hypodense region in the adjacent liver\ncompatible with the findings at CT. Images demonstrate the needle within the\ngallbladder lumen and subsequently complete decompression of the gallbladder\nand adjacent liver collection.", + "output": "Successful US-guided placement of ___ pigtail catheter into the\ngallbladder. Samples was sent for microbiology evaluation." + }, + { + "input": "The liver is normal in echotexture, without focal lesions or intrahepatic\nbiliary ductal dilatation. Main portal vein is patent with hepatopetal flow.\nThe CBD measures 6 mm. The patient is status post cholecystectomy. Imaged\nportion of the pancreas appears within normal limits, without masses or\npancreatic ductal dilation, with portions of the pancreatic tail obscured by\noverlying bowel gas. The spleen measures 12.2 cm, and is normal in\nechogenicity.\n\nThe right kidney measures 10.7 cm. The left kidney measures 11.6 cm. Normal\ncortical echogenicity and corticomedullary differentiation is seen\nbilaterally. There is no evidence of masses, stones or hydronephrosis in the\nkidneys. Visualized portions of aorta and IVC are within normal limits. There\nis no ascites.", + "output": "Unremarkable abdominal ultrasonographic examination in this patient with prior\ncholecystectomy." + }, + { + "input": "Tissue density: B - There are scattered areas of fibroglandular density.\nThere is an 1.1 cm poorly defined mass in the region of the right palpable\nlump at 4 o'clock, medially. There are no associated microcalcifications. \nOtherwise, both breasts are without suspicious dominant masses, architectural\ndistortion or grouped microcalcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right breast at 4 o'clock, 9 cm\nfrom the nipple demonstrates an area of focal skin thickening with hyperechoic\ntissue and a central hypoechoic tract, together measuring 1.6 x 1.2 x 1.7 cm. \nThis is poorly defined with minimal vascularity, consistent with an area of\nresolving infection. There is no discrete drainable abscess collection.", + "output": "Focal area of resolving infection best seen by ultrasound measuring 1.7 cm. \nThis may have been an infected sebaceous cyst. This does not have the\nappearance of carcinoma.\n\nRECOMMENDATION(S): Clinical followup with surgical consultation.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 2 Benign." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has mild partially calcified atheromatous plaque\nat the carotid bulb.\nThe peak systolic velocity in the right common carotid artery is 65 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 87 cm/s, 78 cm/s, and respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 24 cm/s.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of148 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has mild partially calcified atheromatous plaque\nin the proximal common carotid artery, and the carotid bulb.\nThe peak systolic velocity in the left common carotid artery is 109 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 69 cm/s, 105 cm/s, and 87 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 32 cm/s.\nThe ICA/CCA ratio is 0.96.\nThe external carotid artery has peak systolic velocity of 146 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "1. Mild partially calcified atheromatous plaque involving the proximal left\ncommon carotid artery and the bilateral carotid bulbs.\n2. No significant stenosis of the extracranial portions of the carotid\narteries and vertebral arteries." + }, + { + "input": "Tissue density: There are scattered areas of fibroglandular density.\nEctatic ducts are noted in the retroareolar region of the right breast. These\nare unchanged from exams dating back to ___. The right breast demonstrates a\nribbon clip at the 3 o'clock location middle depth. There is no mammographic\nfinding at the site of the patient's clinical concern in the left breast.\nThere is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications in either breast.\n\nBILATERAL BREAST ULTRASOUND: In the right retroareolar region at 11 o'clock,\n6 cm from the nipple, dilated tubular structures are seen without any\nintraluminal debris or associated mass. These represent stable ectatic ducts.\n\nIn the superficial left breast at 2 o'clock, 7 cm from the nipple, there are\ntwo distinct adjacent ill-defined hyperechoic lesions with central areas of\nhypoechogenicity that span a total of 4 cm. The more medial lesion measures\n1.3 x 0.6 x 1.4 cm, and the immediately adjacent lateral lesion measures 1.0\n0.6 7.6 cm. The medial lesion is palpable.\nThese may represent foci of fat necrosis or hematoma, but the patient can not\nrecall inciting trauma, but notes easy bruisability.", + "output": "Two hyperechoic lesions in the left breast at 2 o'clock, 7 cm from nipple,\nwhich may represent fat necrosis or hematoma formation.\n\nEctatic right breast retroareolar ducts, stable since ___.\n\nRECOMMENDATION: Followup left breast ultrasound in 1 month.\n\nNOTIFICATION: The findings and followup options were discussed with the\npatient, who elected to 1 month followup left breast ultrasound to document\nstability rather than pursuing ultrasound-guided core biopsy at this time.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At 2 o'clock, 7 cm from the nipple, there is in area of some ill-defined hyper\nechoic lesions with central hypo echogenicity. These span a 3 cm region,\npreviously reported to span 4 cm. The 2 more discrete lesions within this\narea measure 10 x 5 x 7 mm and 9 x 5 x 7 mm respectively. These appear to have\ndecreased in size since the prior study with the hypoechoic components\nbecoming slightly more prominent. Appearances are suggestive of resolving\nhematoma/fat necrosis. No suspicious mass is seen.", + "output": "Resolving hematoma/ fat necrosis. No sonographic evidence of malignancy.\n\nRECOMMENDATION: Annual mammography. On the final disposition of any clinical\nfindings should be based on clinical grounds.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy. The patient states she will followup with ___, nurse practitioner\nin the ___.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: B- There are scattered areas of fibroglandular density.\n\n There is no dominant mass, architectural distortion or suspicious grouped\nmicrocalcifications.\n\nLEFT BREAST ULTRASOUND: Targeted sonography of the left breast at 2 o'clock\nwas performed to follow-up the previously noted abnormalities. The appearance\nof the breast is entirely normal in this region 6-7 cm from nipple. \nPreviously identified findings are no longer seen.", + "output": "No mammographic evidence of malignancy.\n\nSonographic resolution of previously noted benign findings in the left breast\nat 2 o'clock.\n\nRECOMMENDATION(S): Risk and age based screening.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\nBI-RADS: 1 Negative." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has moderate heterogeneous and calcified\natherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 52 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 37 cm/s, 62 cm/s, and 58 cm/s respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 21 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of50 cm/s.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has moderate heterogeneous and calcified\natherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 52 cm/s.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 57 cm/s, 64 cm/s, and 66 cm/s respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 25 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 65 cm/s.\nThe vertebral artery is patent with antegrade flow.", + "output": "Significant atherosclerotic/calcified plaque bilaterally.\n< 40% stenosis of the right internal carotid artery.\n< 40% stenosis of the left internal carotid artery." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses.\nThe asymmetry in the lower right breast is pliable on spot compression views\ncompatible with superimposed fibroglandular tissue. The asymmetry in the\nlateral right breast in the retroglandular fat is pliable but somewhat\npersists on the spot compression views. The asymmetries in the inner left\nbreast persist with spot compression views but have the appearance of\nfibroglandular tissue. Ultrasound was performed of these areas.\n\nBREAST ULTRASOUND: Targeted ultrasound was performed of the left inner breast\nin the area of concern on mammography. At 6 o'clock 5 cm from the nipple\nthere is a 0.4 x 0.4 x 0.3 cm oval circumscribed cyst with debris. Adjacent\nto this cyst at 6 o'clock 5 cm from the nipple is a 0.8 x 0.3 x 0.6 cm\nheterogeneous area with a hyperechoic rim and hypoechoic center. There is no\ninternal vascularity or suspicious posterior features. Ultrasound of other\nareas in the breast appear somewhat similar and this is felt to represent a\nbenign process. Six-month follow-up ultrasound seems reasonable. Targeted\nultrasound was performed of the right lower outer breast. At 7 o'clock 3 cm\nfrom the nipple there is a 0.4 x 0.3 x 0.2 cm oval hypoechoic mass with an\nechogenic rim. This is probably benign and six-month follow-up ultrasound is\nrecommended. No definitive correlate for the mammographic findings were\nidentified.", + "output": "1. Bilateral probably benign asymmetries for which six-month follow-up\nmammogram is recommended.\n2. Bilateral incidental probably benign masses for which six-month follow-up\nultrasound is recommended.\n\nRECOMMENDATION(S): Bilateral diagnostic mammogram and ultrasound in 6 months.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "A loculated fluid collection is seen in the right anterior abdominal wall, the\nlargest component measures approximately 6.1 x 3.5 cm. This pocket was\nlocalized for drain placement.", + "output": "Successful US-guided placement of ___ pigtail catheter into the right\nabdominal wall collection. Sample was sent for microbiology evaluation." + }, + { + "input": "In the left breast, at the 2 o'clock position, 4-5 cm from the nipple, there\nis a 4.0 x 4.5 x 4.0 cm heterogeneous, avascular collection. There is no\noverlying cellulitis or patient pain. Differential diagnosis includes chronic\ngranulomatous mastitis, necrotic mass, and, less likely, atypical acute\nbacterial abscess.", + "output": "4.0 x 4.5 x 4.0 cm heterogeneous, avascular collection in the left breast, at\nthe 2 o'clock position, 4-5 cm from the nipple. No redness or pain to suggest\noverlying cellulitis. Differential diagnosis includes chronic granulomatous\nmastitis, necrotic mass, and, less likely, atypical acute bacterial abscess. \nCollection may still be amenable to imaging guided drainage. Comparison with\nprior mammograms would be useful and short-term follow-up in breast care\n___ diagnostic mammography is recommended.\n\nRECOMMENDATION(S): Recommend short term follow-up in breast Care ___\ndiagnostic mammography." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There is an irregular mass with underlying\narchitectural distortion in the upper outer left breast corresponding to the\narea of concern as indicated by the patient which spans approximately 8.2 x\n4.5 x 5.0 cm. There are slightly heterogeneous microcalcifications in the\nmass spanning approximately 1.4 cm. There is diffuse skin and trabecular\nthickening. There is at least 1 dense left axillary lymph nodes measuring\n2.3 cm in size. These findings are highly suspicious for inflammatory breast\ncancer with metastatic lymphadenopathy. These were all further evaluated with\nultrasound.\n\nThere are three circumscribed round low-density masses in the slightly inner\nright breast located central to slightly above the nipple on the MLO view. \nThese were further evaluated with ultrasound. There is no unexplained\narchitectural distortion or suspicious grouped microcalcifications in the\nright breast.\n\nBREAST ULTRASOUND:\n\nUltrasound of the left breast in the areas of concern as indicated by the\npatient and in the area of concern on mammography was performed. Ultrasound\nwas also performed of the right breast in the areas of concern on mammography.\n\nLEFT: At ___ in the left breast 7 cm from the nipple, there is an\nill-defined irregular hypoechoic mass which is difficult to measure with the\ndominant portion measuring approximately 5.3 x 3.5 cm with extension up into\nthe dermis. This is suspicious for malignancy and biopsy should be\nconsidered.\n\nUltrasound of the left axilla demonstrates at least one markedly abnormal\nlymph node measuring 2.7 x 1.9 x 2.8 cm with a thickened cortex measuring 1.2\ncm. This is concerning for metastatic disease.\n\nRIGHT: At 12 o'clock in the right breast 0-1 cm from the nipple, there is a\n0.5 x 0.3 x 0.2 cm circumscribed oval hypoechoic mass with low level internal\nechoes and posterior acoustic enhancement. At 12 o'clock 0 cm from the\nnipple, there is a predominantly 0.6 x 0.4 x 0.4 cm circumscribed round\npredominantly hypoechoic mass with internal septations or debris. At 9\no'clock 3 cm from the nipple, there is a 0.3 cm simple cyst. At 9 o'clock 0\ncm from the nipple, there is a 0.6 x 0.4 x 0.3 cm circumscribed oval\nhypoechoic mass without internal color flow. At 1 o'clock 2 cm from the\nnipple, there is a 0.9 x 0.3 x 0.6 cm circumscribed oval mass without internal\ncolor flow identified. All these findings are indeterminate. Comparison to\nprior mammograms to assess for stability would be recommended at this time. \nIf these images do not become available at this time, management of these\nfindings will be based on the pathology results of the left breast biopsy.", + "output": "Suspicious left breast mass and distortion spanning approximately 8.2 cm with\nassociated skin and trabecular thickening and suspicious axillary\nlymphadenopathy, concerning for inflammatory breast carcinoma. \nUltrasound-guided biopsy is recommended of the dominant mass and abnormal left\naxillary node.\n\nMultiple probable benign masses in the right breast for which comparison to\noutside imaging is recommended at this time. If these images do not become\navailable, management will be based on the pathologic results of the left\nbreast biopsies.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of left breast mass and dominant\nleft axillary lymph node.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was scheduled for same day biopsy. \nResults were also communicated to ___ NP at time of examination on\n___.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Tissue density: C- The breast tissue is heterogeneously dense which may\nobscure detection of small masses. There is an irregular mass with underlying\narchitectural distortion in the upper outer left breast corresponding to the\narea of concern as indicated by the patient which spans approximately 8.2 x\n4.5 x 5.0 cm. There are slightly heterogeneous microcalcifications in the\nmass spanning approximately 1.4 cm. There is diffuse skin and trabecular\nthickening. There is at least 1 dense left axillary lymph nodes measuring\n2.3 cm in size. These findings are highly suspicious for inflammatory breast\ncancer with metastatic lymphadenopathy. These were all further evaluated with\nultrasound.\n\nThere are three circumscribed round low-density masses in the slightly inner\nright breast located central to slightly above the nipple on the MLO view. \nThese were further evaluated with ultrasound. There is no unexplained\narchitectural distortion or suspicious grouped microcalcifications in the\nright breast.\n\nBREAST ULTRASOUND:\n\nUltrasound of the left breast in the areas of concern as indicated by the\npatient and in the area of concern on mammography was performed. Ultrasound\nwas also performed of the right breast in the areas of concern on mammography.\n\nLEFT: At ___ in the left breast 7 cm from the nipple, there is an\nill-defined irregular hypoechoic mass which is difficult to measure with the\ndominant portion measuring approximately 5.3 x 3.5 cm with extension up into\nthe dermis. This is suspicious for malignancy and biopsy should be\nconsidered.\n\nUltrasound of the left axilla demonstrates at least one markedly abnormal\nlymph node measuring 2.7 x 1.9 x 2.8 cm with a thickened cortex measuring 1.2\ncm. This is concerning for metastatic disease.\n\nRIGHT: At 12 o'clock in the right breast 0-1 cm from the nipple, there is a\n0.5 x 0.3 x 0.2 cm circumscribed oval hypoechoic mass with low level internal\nechoes and posterior acoustic enhancement. At 12 o'clock 0 cm from the\nnipple, there is a predominantly 0.6 x 0.4 x 0.4 cm circumscribed round\npredominantly hypoechoic mass with internal septations or debris. At 9\no'clock 3 cm from the nipple, there is a 0.3 cm simple cyst. At 9 o'clock 0\ncm from the nipple, there is a 0.6 x 0.4 x 0.3 cm circumscribed oval\nhypoechoic mass without internal color flow. At 1 o'clock 2 cm from the\nnipple, there is a 0.9 x 0.3 x 0.6 cm circumscribed oval mass without internal\ncolor flow identified. All these findings are indeterminate. Comparison to\nprior mammograms to assess for stability would be recommended at this time. \nIf these images do not become available at this time, management of these\nfindings will be based on the pathology results of the left breast biopsy.", + "output": "Suspicious left breast mass and distortion spanning approximately 8.2 cm with\nassociated skin and trabecular thickening and suspicious axillary\nlymphadenopathy, concerning for inflammatory breast carcinoma. \nUltrasound-guided biopsy is recommended of the dominant mass and abnormal left\naxillary node.\n\nMultiple probable benign masses in the right breast for which comparison to\noutside imaging is recommended at this time. If these images do not become\navailable, management will be based on the pathologic results of the left\nbreast biopsies.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy of left breast mass and dominant\nleft axillary lymph node.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with this plan. She was scheduled for same day biopsy. \nResults were also communicated to ___ NP at time of examination on\n___.\n\nBI-RADS: 5 Highly Suggestive of Malignancy." + }, + { + "input": "Pre-procedure imaging again demonstrates an ill-defined irregular hypoechoic\nmass at ___ in the left breast as well as an enlarged left axillary lymph\nnode, both of which were targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___. ___, M.D.. The procedure was supervised by ___,\nM.D. (attending).\n\nDescription:\n\nLESION 1 (left breast mass):\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle and 14 gauge Cetera spring-loaded biopsy device were used to\nobtain 5 cores. Next, a percutaneous HydroMark coil was deployed under\nultrasound guidance.\n\nLESION 2 (axillary lymph node):\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 15-gauge\ncoaxial needle and 16-gauge Achieve needle were used to obtain 4 cores. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance.\n\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof both clips. There are expected post biopsy changes with no significant\nhematoma.", + "output": "Technically successful US-guided core biopsy of the left breast mass and\nenlarged left axillary lymph node.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Pre-procedure imaging again demonstrates an ill-defined irregular hypoechoic\nmass at ___ in the left breast as well as an enlarged left axillary lymph\nnode, both of which were targeted for biopsy.\n\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies/Medications: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\n\nClinicians: ___. ___, M.D.. The procedure was supervised by ___,\nM.D. (attending).\n\nDescription:\n\nLESION 1 (left breast mass):\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 13-gauge\ncoaxial needle and 14 gauge Cetera spring-loaded biopsy device were used to\nobtain 5 cores. Next, a percutaneous HydroMark coil was deployed under\nultrasound guidance.\n\nLESION 2 (axillary lymph node):\nUsing ultrasound guidance, aseptic technique and local anesthesia, a 15-gauge\ncoaxial needle and 16-gauge Achieve needle were used to obtain 4 cores. Next,\na percutaneous HydroMark coil was deployed under ultrasound guidance.\n\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM: CC and lateral views confirm appropriate placement\nof both clips. There are expected post biopsy changes with no significant\nhematoma.", + "output": "Technically successful US-guided core biopsy of the left breast mass and\nenlarged left axillary lymph node.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the Radiology department with the results and the appropriate\nrecommendations.\n\n\nAs the Attending radiologist, I personally supervised the Fellow during the\nkey components of the above procedure and I reviewed and agree with the\nFellow's findings and dictation." + }, + { + "input": "Targeted ultrasound of the left breast tumor mass at ___ o'clock 7 cm from the\nnipple demonstrates an irregular hypoechoic mass which measures 3.5 x 2.5 x\n3.8 cm, with some posterior shadowing, consistent with the previously biopsied\ncarcinoma. There is persistent but improving extension into the skin. On\ntoday's imaging the medial margin of the tumor is seen within 2 cm of the base\nof the nipple.\n\nScanning of the left axilla demonstrates a 1.8 cm abnormal lymph node with a\ncoil clip with cortical thickening measuring 7 mm (compared to prior 12 mm).", + "output": "Interval improvement with decreased size of the left breast tumor at ___\no'clock 7 cm from the nipple now measuring 3.5 x 2.5 x 3.8 cm and interval\ndecrease in size and cortical thickness of the abnormal left axillary lymph\nnode.\n\nRECOMMENDATION(S): Continued neoadjuvant therapy per her oncology team.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 6 Known Biopsy-Proven Malignancy." + }, + { + "input": "In the right breast at 1 o'clock 0-1 cm from the nipple there is a hypoechoic\nmass which was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P. The procedure was supervised by ___\n___, MD..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of a right breast mass.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the BreastCare ___ provider with the results and the appropriate\nrecommendations." + }, + { + "input": "Targeted ultrasound ___ o'clock right breast 0-5 cm from the nipple performed\nto cover area of concern on MRI. There is a 0.5 x 0.4 x 0.3 cm slightly\nlobulated hypoechoic mass with posterior acoustic enhancement 1 o'clock right\nbreast 0-1 cm from the nipple which correlates to the MRI Finding. There is\nmild internal vascularity identified. No additional suspicious cystic or\nsolid mass identified.", + "output": "0.5 cm hypoechoic mass 1 o'clock right breast 0-1 cm from the nipple\ncorresponding to MRI finding. Ultrasound-guided biopsy is recommended.\n\nRECOMMENDATION(S): Ultrasound-guided biopsy right breast.\n\nNOTIFICATION: Findings and recommendation for biopsy were reviewed with the\npatient who agrees with the plan. She is scheduled for same day biopsy.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "In the right breast at 1 o'clock 0-1 cm from the nipple there is a hypoechoic\nmass which was targeted for biopsy.\nPROCEDURE: Consent: The procedure, risks, benefits and alternatives were\ndiscussed with the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers, with\nconfirmation of side and site.\nAllergies / Medication: The patient's medication list and history of allergies\nwere reviewed prior to beginning the procedure.\nClinicians: ___, N.P. The procedure was supervised by ___\n___, MD..\nDescription: Using ultrasound guidance, aseptic technique and local\nanesthesia, a 13-gauge coaxial needle was placed adjacent to the lesion and 5\ncores were obtained using a 14-gauge Bard spring-loaded biopsy device. Next,\na percutaneous ribbon clip was deployed under ultrasound guidance. The needle\nwas removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology.\nAnesthesia: ___ cc 1% lidocaine.\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nPOST-PROCEDURE MAMMOGRAM:CC and lateral views confirm appropriate clip\nplacement.", + "output": "Technically successful US-guided core biopsy of a right breast mass.\n\nOnce the pathology report is available and concordance is established an\naddendum will be generated to this report, and the patient will be contacted\nby the BreastCare ___ provider with the results and the appropriate\nrecommendations." + }, + { + "input": "BILATERAL DIAGNOSTIC MAMMOGRAM INTERPRETED WITH CAD:\n\nThere are scattered areas of fibroglandular density. There is no dominant\nmass, unexplained architectural distortion or suspicious grouped\nmicrocalcifications. An asymmetry in the medial right breast has the\nappearance of breast tissue on additional spot compression and rolled medial\nviews performed today.\n\nRIGHT BREAST ULTRASOUND:\n\nThe right breast was scanned in the area of clinical concern predominantly\ninvolving the upper outer right breast, as directed by the patient. Normal\nbreast tissue was identified. No suspicious abnormalities identified.", + "output": "No specific evidence of malignancy.\n\nRECOMMENDATION: Further management for the area of clinical concern in the\nright breast should be based on the clinical assessment. Return to screening\nmammography is recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "Ultrasound of the upper-outer left breast was performed in the area of\npreviously palpable lump, however no focal mass is seen. Normal glandular\ntissue is seen throughout the upper-outer quadrant. Physical examination of\nthe area where the patient previously reported a lump was performed by Dr.\n___. No palpable lumps and no thickening was felt.\nOn review of the diagnostic mammogram from ___, there are bilateral\ndensities, which have bilaterally increased since ___. No discrete\nsuspicious mass is seen.", + "output": "No discrete sonographic abnormality in the upper-outer left breast.\n\nRECOMMENDATION(S): Diagnostic mammogram and ultrasound of the left breast in\n6 months seems reasonable. Clinical follow-up is also recommended.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 3 Probably Benign." + }, + { + "input": "At 8 o'clock position, 4 cm from the nipple, there is a 1.8 cm solid\nhypoechoic mass.\n\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: Dr. ___. The procedure was supervised by ___, M.D.\n(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 8-gaugecoaxial needle was placed adjacent to the lesion\nand using a 9-gauge ATEC vacuum-assisted biopsy device, 12 cores were\nobtained. Next, a percutaneous CeleroMark dumbbell was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and flow cytometry.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nBILATERAL POST-PROCEDURE MAMMOGRAM:\nBilateral mammography was offered to the patient as the most recent exam was\n___ years ago and the patient has current residence is remote from the\nhospital.\n\nThere are scattered areas fibroglandular densities. CC and lateral views\nconfirm appropriate clip placement the with post biopsy changes in the inner,\ninferior left breast. Two additional biopsy clips in the inferior, inner\nbreast correspond to patient's prior biopsies. There is no unexplained\narchitectural distortion or suspicious grouped microcalcifications in either\nbreast.", + "output": "Technically successful US-guided core biopsy of the left breast 8 o'clock\nlesion. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient." + }, + { + "input": "Targeted ultrasound exam of the left inferior inner breast in the area of\nconcern on recent chest CT was performed. At 8 o'clock position, 4 cm from the\nnipple, there is a hypoechoic irregular solid mass measuring 1.8 x 0.9 x 0.9\ncm with internal vascularity and no definite posterior acoustic features. This\nmass is felt to correspond to CT finding of ___.", + "output": "A 1.8 cm solid irregular mass corresponds left breast lesion seen on recent\nchest CT dated ___, and for which ultrasound-guided core biopsy was\nperformed immediately following the completion of this study.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 4B Suspicious - moderate suspicion for \nmalignancy." + }, + { + "input": "At 8 o'clock position, 4 cm from the nipple, there is a 1.8 cm solid\nhypoechoic mass.\n\n\nPROCEDURE: The procedure, risks, benefits and alternatives were discussed\nwith the patient and written informed consent was obtained.\nTime-out certification: Performed using three patient identifiers.\nAllergies and/or Medications: Reviewed prior to the procedure.\nClinicians: Dr. ___. The procedure was supervised by ___, M.D.\n(Attending).\nDescription: Using ultrasound guidance, aseptic technique and 1% lidocaine for\nlocal anesthesia, a 8-gaugecoaxial needle was placed adjacent to the lesion\nand using a 9-gauge ATEC vacuum-assisted biopsy device, 12 cores were\nobtained. Next, a percutaneous CeleroMark dumbbell was deployed under\nultrasound guidance. The needle was removed and hemostasis was achieved.\n\nEstimated blood loss: < 1 cc.\nSpecimens: Sent to pathology and flow cytometry.\nAnesthesia: ___ cc 1% lidocaine\nComplications: No immediate complications.\nPost procedure diagnosis: Same.\n\nBILATERAL POST-PROCEDURE MAMMOGRAM:\nBilateral mammography was offered to the patient as the most recent exam was\n___ years ago and the patient has current residence is remote from the\nhospital.\n\nThere are scattered areas fibroglandular densities. CC and lateral views\nconfirm appropriate clip placement the with post biopsy changes in the inner,\ninferior left breast. Two additional biopsy clips in the inferior, inner\nbreast correspond to patient's prior biopsies. There is no unexplained\narchitectural distortion or suspicious grouped microcalcifications in either\nbreast.", + "output": "Technically successful US-guided core biopsy of the left breast 8 o'clock\nlesion. Pathology is pending.\n\nThe patient expects to hear the pathology results from Dr. ___ in ___\nbusiness days. Standard post care instructions were provided to the patient." + }, + { + "input": "The right common femoral artery and vein are patent. Arising from the right\ncommon femoral artery, is a structure which measures approximately 4 x 5 mm\nwith internal flow and surrounding thrombus, most consistent with a partially\nthrombosed pseudoaneurysm. The neck of the pseudoaneurysm measures\napproximately 4 mm in width. Just deep to the skin surface, there is a 7 x 7\nmm hypoechoic avascular lesion, consistent with a hematoma which has decreased\nin size as compared to prior examination.", + "output": "Stable partially thrombosed pseudoaneurysm arising from the right common\nfemoral artery. Interval decrease in size of right femoral groin hematoma." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 58 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 45, 40, and 71 cm/sec, respectively. The peak end\ndiastolic velocity in the right internal carotid artery is 15 cm/sec.\nThe ICA/CCA ratio is 1.2.\nThe external carotid artery has peak systolic velocity of 52 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 60 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 27, 44, and 67 cm/sec, respectively. The peak end\ndiastolic velocity in the left internal carotid artery is 16 cm/sec.\nThe ICA/CCA ratio is 1.1.\nThe external carotid artery has peak systolic velocity of 66 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No evidence of atherosclerotic disease in the bilateral carotid vasculature. \nTortuous bilateral ICAs are incidentally noted." + }, + { + "input": "Tissue density: D - The breast tissue is extremely dense which lowers the\nsensitivity of mammography.\nThe area of prior asymmetry in the right upper outer quadrant is not\npersistent on today's imaging. The breast parenchyma is without any dominant\nmass, architectural distortion or suspicious grouped calcifications.\n\nBREAST ULTRASOUND: Targeted ultrasound of the right upper outer quadrant was\nperformed from 9 o'clock through 12 o'clock and demonstrates dense parenchyma\nwithout an underlying solid or cystic mass.", + "output": "No specific evidence of malignancy. The area of prior concern represents\nglandular tissue.\n\nRECOMMENDATION: Annual mammography.\n\nNOTIFICATION: Findings reviewed with the patient at the completion of the\nstudy.\n\nBI-RADS: 1 Negative." + }, + { + "input": "Tissue composition: Heterogeneous background echotexture.\n\nThere is no solid or cystic mass.\nThe retroareolar regions are unremarkable.\nBoth axillae demonstrate normal-appearing lymph nodes without cortical\nthickening.", + "output": "No sonographic evidence of malignancy in either breast.\n\nRECOMMENDATION(S): Age and risk appropriate screening.\n\nNOTIFICATION: Findings and recommendations were reviewed with the patient at\nthe completion of the study.\n\n\n\nBI-RADS: 1 Negative." + }, + { + "input": "The right breast was scanned from ___ o'clock 5-6 cm from the nipple which is\nthe palpable area as indicated by the patient. Dense tissue noted underlying\nthe palpable area with a 4 mm incidental simple cysts. No solid lesion of\nconcern underlying the palpable area.", + "output": "No ultrasound lesion underlying palpable area. Incidental 4 mm simple cyst\nnoted.\n\nRECOMMENDATION: Final disposition of the palpable area should be based on\nclinical evaluation. If palpable area persists repeat ultrasound could be\nperformed.\n\nNOTIFICATION: Findings and the recommendations were reviewed with the patient\nat the completion of the study.\n\n\n\n BI-RADS: 1 Negative." + }, + { + "input": "Targeted ultrasound of the left upper inner quadrant at the patient's palpable\nmass at 10 o'clock 2 cm from the nipple demonstrates a 3.6 x 1.3 x 3.0 cm oval\nhypoechoic mass with dominant vascularity and no significant posterior\nfeatures. Some internal septations are noted. The appearance is most\nconsistent with a fibroadenoma.", + "output": "3.6 cm probable left breast fibroadenoma at 10 o'clock. Given the size,\nconsideration should be given to excision or biopsy for pathology.\n\nRECOMMENDATION(S): Left breast ultrasound-guided core biopsy or excisional\nbiopsy.\n\nNOTIFICATION: The findings and recommendation for biopsy versus excision were\ndiscussed with the patient. Since the patient is considering top surgery, the\npatient will discuss with her provider the options for excision.\n\nBI-RADS: 4A Suspicious - low suspicion for malignancy." + }, + { + "input": "There is no evidence of intraperitoneal fluid in any of the 4 quadrants.", + "output": "No ascites identified." + }, + { + "input": "RIGHT:\nThe right carotid vasculature has no significant atherosclerotic plaque.\nThe peak systolic velocity in the right common carotid artery is 65 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal right internal\ncarotid artery are 56, 57, and 65 cm/sec, respectively. The peak end diastolic\nvelocity in the right internal carotid artery is 24 cm/sec.\nThe ICA/CCA ratio is 1.0.\nThe external carotid artery has peak systolic velocity of 113 cm/sec.\nThe vertebral artery is patent with antegrade flow.\n\nLEFT:\nThe left carotid vasculature has no significant atherosclerotic plaque.\nThe peak systolic velocity in the left common carotid artery is 56 cm/sec.\nThe peak systolic velocities in the proximal, mid, and distal left internal\ncarotid artery are 53, 66, and 75 cm/sec, respectively. The peak end diastolic\nvelocity in the left internal carotid artery is 28 cm/sec.\nThe ICA/CCA ratio is 1.3.\nThe external carotid artery has peak systolic velocity of 73 cm/sec.\nThe vertebral artery is patent with antegrade flow.", + "output": "No hemodynamically significant stenosis.\n\nNo significant atherosclerotic plaque in the right or left carotid arteries." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere is increased density in the right retroareolar breast corresponding to\nthe BB indicating the site of palpable concern. The CC view of the left\nbreast demonstrates a similar area of increased retroareolar density. The\nmammographic appearance is suggestive of bilateral gynecomastia. There is no\ndominant mass, unexplained architectural distortion or suspicious grouped\nmicrocalcifications in either breast on these limited CC views.\n\nBREAST ULTRASOUND:\nTargeted ultrasound in the area of palpable concern in the right retroareolar\nbreast demonstrates benign appearing breast tissue consistent with\ngynecomastia. The left retroareolar breast was scanned for comparison, and\nalso demonstrates benign appearing breast tissue consistent with gynecomastia.\nNo suspicious mass is identified in the scanned portion of either breast.\n\nPhysical examination of both breasts demonstrates bilateral mobile\nretroareolar nodules which are nontender.", + "output": "Bilateral gynecomastia.\n\nRECOMMENDATION(S): Clinical follow-up.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Tissue density: A- The breast tissue is almost entirely fatty.\nThere is increased density in the right retroareolar breast corresponding to\nthe BB indicating the site of palpable concern. The CC view of the left\nbreast demonstrates a similar area of increased retroareolar density. The\nmammographic appearance is suggestive of bilateral gynecomastia. There is no\ndominant mass, unexplained architectural distortion or suspicious grouped\nmicrocalcifications in either breast on these limited CC views.\n\nBREAST ULTRASOUND:\nTargeted ultrasound in the area of palpable concern in the right retroareolar\nbreast demonstrates benign appearing breast tissue consistent with\ngynecomastia. The left retroareolar breast was scanned for comparison, and\nalso demonstrates benign appearing breast tissue consistent with gynecomastia.\nNo suspicious mass is identified in the scanned portion of either breast.\n\nPhysical examination of both breasts demonstrates bilateral mobile\nretroareolar nodules which are nontender.", + "output": "Bilateral gynecomastia.\n\nRECOMMENDATION(S): Clinical follow-up.\n\nNOTIFICATION: Findings and recommendation were reviewed with the patient who\nagrees with the plan.\n\nBI-RADS: 2 Benign." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated moderate\nascites. A suitable target in the deepest pocket in the right lower quadrant\nwas selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: right lower quadrant\nFluid: 4 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and existing annual signed consent was reviewed.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components\nof the procedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 4 L of fluid were removed and sent for requested analysis." + }, + { + "input": "Limited grayscale ultrasound imaging of the abdomen demonstrated a large\namount of ascites. A suitable target in the deepest pocket in the left lower\nquadrant was selected for paracentesis.\n\nPROCEDURE: Ultrasound guided diagnostic and therapeutic paracentesis\nLocation: left lower quadrant\nFluid: 5.95 L of clear, straw-colored fluid\nSamples: Fluid samples were submitted to the laboratory the requested analysis\n(chemistry, hematology, microbiology).\n\nThe procedure, risks, benefits and alternatives were discussed with the\npatient and written informed consent was obtained.\n\nA preprocedure time-out was performed discussing the planned procedure,\nconfirming the patient's identity with 3 identifiers, and reviewing a\nchecklist per ___ protocol.\n\nUnder ultrasound guidance, an entrance site was selected and the skin was\nprepped and draped in the usual sterile fashion. 1% lidocaine was instilled\nfor local anesthesia.\n\nAscites fluid was aspirated via a 5 ___ catheter advanced into the largest\nfluid pocket.\n\nThe patient tolerated the procedure well without immediate complication.\nEstimated blood loss was minimal.\n\nDr. ___ supervised the trainee during the key components of the\nprocedure and reviewed and agrees with the trainee's findings.", + "output": "1. Technically successful ultrasound guided diagnostic and therapeutic\nparacentesis.\n2. 5.95 L of fluid were removed and samples were sent for requested analysis." + }, + { + "input": "The uterus measures 10.0 x 6.1 x 7.0 cm. A balloon catheter is demonstrated\nwithin the endometrial cavity. In addition, echogenic, vascularized material\nis demonstrated along the anterior right cavity measuring 4.6 x 2.4 x 2.4 cm.\n\nThere appears to be extension of multiple parallel linear echogenic structures\nextending through the posterior myometrium ending to the serosa of the uterine\nfundus. It is unclear if this is an extension of the balloon catheter or if\nthis could represent a foreign body.\n\nSpectral and color Doppler was performed in the right anterior and lateral\nmyometrium demonstrating a large amount of vascularity with increased\nvelocities. Peak systolic velocity in this region measures 137\ncentimeters/second with end-diastolic velocity is 74 cm per second. This most\nlikely represents an arteriovenous fistula.\n\nThe ovaries are not visualized. There is a trace amount of free fluid.", + "output": "1. Large amount of vascularity demonstrating increased velocities to 137\ncm/sec within the right ___ myometrium consistent with a likely\narteriovenous fistula.\n2. Echogenic vascularized material within the upper endometrial cavity\nconsistent with vascularized retained products of conception.\n3. Parallel echogenic linear structures extending from the endometrial cavity\nthroughout the posterior fundal myometrium extending to the serosa of the\nfundal uterus. It is unclear if this represents an extension of the balloon\ncatheter or if this could represent a foreign body.\n4. Balloon catheter in place within the endometrial cavity.\n\nRECOMMENDATION(S): Recommend consultation with interventional radiology.\n\nNOTIFICATION: The results of this examination for relayed to Dr. ___\nDr. ___ by ___ on ___ at 09:20, 5 min\nafter the completion of the examination." + } + ] +} \ No newline at end of file