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data_prepare.py

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+import os
+import random
+import pandas as pd
+
+
+def get_training_batch(root):
+        """
+        the proportional distribution of training data across each batch for classification,
+        disease localization, report generation, and segmentation tasks to be 0.15/0.2/0.5/0.15
+        """
+        classification_label = ['Atelectasis', 'Calcification of the Aorta', 'Cardiomegaly', 'Consolidation', 'Edema', \
+            'Emphysema', 'Enlarged Cardiomediastinum', 'Fibrosis', 'Fracture', 'Hernia', 'Infiltration', 'Lung Lesion', \
+            'Lung Opacity', 'Mass', 'No Finding', 'Nodule', 'Pleural Effusion', 'Pleural Other', 'Pleural Thickening', \
+            'Pneumomediastinum', 'Pneumonia', 'Pneumoperitoneum', 'Pneumothorax', 'Subcutaneous Emphysema', 'Support Devices', 'Tortuous Aorta']
+
+        batch_size = 256
+        cla_num = int(batch_size * 0.15)
+        loc_num = int(batch_size * 0.2)
+        report_num = int(batch_size * 0.5)
+        seg_num = batch_size - (cla_num + loc_num + report_num)
+
+        read = lambda x, y : pd.read_csv(x, sep='\t', header=None, chunksize=y)
+
+        ### classification and report generation
+        # Instruction: 
+        #   what disease does this image have?
+        #   is {} in this image?
+        mimic = f'{root}/MIMIC_classification_report-generation_train.tsv'
+        mimic_chunck = read(mimic, max(cla_num, report_num))
+        cla_mimic_info = []
+        report_mimic_info = []
+        for chunck in mimic_chunck:
+            for info in chunck.values.tolist():
+                report = info[1]
+                label = info[2]
+                dicom_id = info[-1]
+                if len(report_mimic_info) < report_num:
+                    report_mimic_info.append(
+                        ['describe the image', report, dicom_id, 'report generation']
+                    )
+                if len(cla_mimic_info) < int(cla_num*0.6):
+                    if random.randint(0, 1):
+                        cur_info = ['what disease does this image have?', f"there are {', '.join(label.split('&&'))}", dicom_id, 'classification']
+                    else:
+                        vqa_label = classification_label[random.randint(0, len(classification_label)-1)]
+                        if vqa_label in label:
+                            cur_info = [f'Is {vqa_label} in this image?', f'yes, there is {vqa_label}.', dicom_id, 'classification']
+                        else:
+                            cur_info = [f'Is {vqa_label} in this image?', f'no {vqa_label}.', dicom_id, 'classification']
+                    cla_mimic_info.append(cur_info)
+            break
+        del mimic_chunck
+
+        def organize_data(file, chunck_size, task, instruction, label_index, image_index, instruction_index=None, label_format=None):
+            res = []
+            chunck_size = max(chunck_size, 1)
+            chuncks = read(file, chunck_size)
+            for chunck in chuncks:
+                for info in chunck.values.tolist():
+                    if instruction_index is not None:
+                        instruction = instruction.format(info[instruction_index])
+                        ans = info[label_index]
+                    elif label_format is not None:
+                        label_ans_list = label_format(info[label_index])
+                        label_ans = label_ans_list[random.randint(0, len(label_ans_list)-1)].split(',')
+                        if len(label_ans) == 1:
+                            label, ans = label_ans_list[0].split(',')[0], label_ans[0]
+                        else:
+                            label, ans = label_ans
+                        label = label.strip()
+                        instruction =  instruction.format(label)
+                        ans = ans.strip()
+                    if len(res) < chunck_size:
+                        res.append(
+                            [instruction, ans, info[image_index], task]
+                        )
+                break
+            return res
+
+        ### classification: severity
+        # Instruction: 
+        #   what is the level of {}?
+        mimic_severity = f'{root}/MIMIC_classification-severity_train.tsv'
+        cla_sev_mimic_info = organize_data(
+            mimic_severity, int(cla_num*0.2), 'classification_sev', 'what is the level of {}?', 1, -1, label_format=lambda x:x.split('&&')
+        )
+
+        ### classification: location
+        # Instruction: 
+        #   where is {}?
+        mimic_location = f'{root}/MIMIC_classification-location_train.tsv'
+        cla_loc_mimic_info = organize_data(
+            mimic_location, int(cla_num*0.2), 'classification_loc', 'where is {}?', 1, -1, label_format=lambda x:x.split('&')
+        )
+
+        ### localization
+        # Instruction: 
+        #   give the accurate bbox of {}.
+        chestX_det = f'{root}/ChestX_Det_localization.tsv'
+        chestX_det_info = organize_data(
+            chestX_det, loc_num, 'localization', 'Give the accurate bbox of {}', 2, -1, instruction_index=1, 
+        )
+
+        ### segmentation
+        # Instruction: 
+        #   describe the image.
+        cheXmask_heart = f'{root}/CheXmask_heart_segmentation.tsv'
+        cheXmask_heart_info = organize_data(
+            cheXmask_heart, seg_num, 'segmentation', 'please segment the {} from the given image.', 2, -1, instruction_index=1
+        )
+
+        batch_info = cla_mimic_info + report_mimic_info + cla_loc_mimic_info + cla_sev_mimic_info + chestX_det_info + cheXmask_heart_info
+        random.shuffle(batch_info)
+        batch_df = pd.DataFrame(batch_info)
+        return batch_df
+
+
+if __name__ == '__main__':
+    root = ''
+    get_training_batch(root)

demo.tsv

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+0	describe the image	mild pulmonary edema may be minimally worse in the interval . cardiac, mediastinal, and hilar contours are unchanged . patchy opacities in the lung bases likely reflect areas of atelectasis, but aspiration or infection is not completely excluded . no pleural effusion or pneumothorax is identified . clips from prior cholecystectomy are noted in the right upper quadrant . mild pulmonary edema, minimally worse in the interval . continued bibasilar patchy opacities, likely atelectasis but aspiration or infection is not excluded  .	ec664ffb-65f72181-2431d6b1-b848135a-af2e99bd	report generation
+1	describe the image	new ng tube has been placed with tip ending in the distal gastric cavity . moderate cardiomegaly and widened mediastinum are stable . minimal improvement of right base ventilation . stable left base atelectasis and pleural effusion . there is no pneumothorax . right ij catheter has been removed  .	ba050e82-93a0dc49-f4c2aba7-9a89f10e-96068843	report generation
+2	please segment the heart from the given image.	159,368,157,353,163,333,169,312,178,291,190,272,208,261,227,257,242,256,258,258,274,261,285,261,299,267,315,283,334,303,352,320,369,337,380,356,374,377,355,392,326,399,295,404,262,403,232,399,204,393,177,384,159,368,157,353,163,333,169,312	1c6cd000-cdb23e42-ae079390-6bdb7513-ef372ae0	segmentation
+3	please segment the heart from the given image.	192,335,193,321,202,305,211,289,221,272,235,259,252,253,270,252,286,256,302,262,318,267,330,268,340,276,352,293,364,314,374,332,384,347,392,365,386,382,366,392,339,393,312,393,282,385,256,376,230,366,206,352,192,335,193,321,202,305,211,289	f6f7a4f7-9a31cf05-086da87b-1c6b85a0-938ca55a	segmentation
+4	give the accurate bbox of Cardiomegaly	690,710,908,761	59568.jpg	localization
+5	describe the image	heart size is within normal limits, substantially decreased in size compared to the prior exams . the mediastinal contours are normal . hilar contours have decreased in size, with minimal fullness of the right hila likely reflective of residual lymphadenopathy . pulmonary vasculature is normal . linear opacity in the left mid lung field likely reflects atelectasis or scarring . previously demonstrated diffuse airspace opacities have resolved . no focal consolidation, pleural effusion, or pneumothorax is present . no acute osseous abnormality is visualized . previously noted diffuse airspace opacities have resolved with only minimal residual atelectasis or scarring in the left mid lung field . no new focal consolidation . no pulmonary edema with normalization of the heart size  .	03de5cbb-0baa7a8a-c6e715bc-e53cf750-2f38fb6d	report generation
+6	where is atelectasis?	base	4241de56-f62e7cd8-d1747249-c31f9cef-949d3179	classification_loc
+7	give the accurate bbox of Cardiomegaly	421,474,807,667	39697.jpg	localization
+8	describe the image	right basilar chest tube remains in unchanged position . small right hydropneumothorax is unchanged . there is increased patchy opacification within the right lung base . this could reflect asymmetric pulmonary edema given its rapid development over the course of a few hours . multiple scattered ill-defined nodular opacities are compatible with known metastatic disease . the cardiac and mediastinal contours are unchanged . streaky left basilar atelectasis is re- demonstrated . unchanged appearance of small right hydropneumothorax . interval development of patchy opacification in the right lung base which given its rapid development may reflect asymmetric pulmonary edema, but is nonspecific, and hemorrhage or infection can have a similar appearance . continued followup is recommended  .	a86af117-3d1dc714-0dfd03b1-ee7b5e1d-ddcde5cf	report generation
+9	describe the image	ap single view of the chest has been obtained with patient in sitting semi-upright position . comparison of the two examinations with less than hours interval demonstrate that the dobbhoff line has been advanced by a few centimeters . the tip of the line is now well away from the site of the hiatus and the position now in the fundus of the stomach . chest findings are unaltered, indicating status post sternotomy, aortic and mitral valve replacement with prostheses, significant cardiac enlargement and moderate degree of chronic pulmonary congestive pattern . no new pulmonary parenchymal infiltrates are identified  .	db97ad09-5358e322-87ee71dc-11b28115-c9c38e71	report generation
+10	give the accurate bbox of Cardiomegaly	610,448,700,593	60774.jpg	localization
+11	what is the level of effusion?	normal	d3a45939-1586213e-2eedfebd-da2cc78a-370d25c9	classification_sev
+12	describe the image	small right effusion is a stable . small right pneumothorax has decreased . right apical chest tube remains in place . cardiomediastinal contours are midline . right lower lobe atelectasis have improved . no other interval change  .	f64050cc-622b03c4-3b375144-9b1fe90c-77b5e31f	report generation
+13	please segment the heart from the given image.	198,348,194,329,196,309,200,288,204,266,208,246,215,234,226,226,237,222,248,221,257,221,265,221,278,229,297,250,321,274,343,297,360,322,370,352,367,374,349,386,328,387,306,389,281,386,259,381,237,374,214,364,198,348,194,329,196,309,200,288	6e61267e-e7e41f12-080c355e-0da3413d-45f4da6a	segmentation
+14	please segment the heart from the given image.	220,344,212,325,210,304,212,281,215,257,219,236,227,222,240,213,252,209,262,207,271,207,280,206,295,212,316,231,343,254,368,275,386,301,396,331,388,357,369,372,348,375,328,377,304,377,285,374,265,369,240,360,220,344,212,325,210,304,212,281	1b234038-83929219-5fa3a7a8-5ba59089-da298259	segmentation
+15	give the accurate bbox of Cardiomegaly	904,819,997,875	45686.jpg	localization
+16	describe the image	et tube tip in satisfactory position approximately . cm above the carina . an ng tube extends beneath the diaphragm, with tip coiled over expected location of the gastric fundus . right ij central line tip over distal svc . left subclavian picc line tip over middistal svc . no pneumothorax detected . there are low inspiratory volumes with bibasilar atelectasis, similar to . there is a small left effusion, which appears new . the possibility of some left lower lobe collapse andor consolidation cannot be excluded . doubt chf .  . small left effusion is new .  . bibasilar patchy opacities similar, possibly slightly worse at the left base  .	692ba57d-340a02a1-c7191350-436db6d0-70cf280b	report generation
+17	please segment the heart from the given image.	199,368,194,349,196,328,201,307,207,284,212,261,221,247,236,238,249,235,262,234,274,235,283,237,293,247,307,266,326,290,344,310,359,330,370,351,369,368,353,378,332,385,310,392,284,396,262,395,240,392,217,384,199,368,194,349,196,328,201,307	a9a74a32-490cae66-d7a2fd39-cab8a408-858f665b	segmentation
+18	give the accurate bbox of Cardiomegaly	163,491,410,793	46978.jpg	localization
+19	give the accurate bbox of Cardiomegaly	181,255,352,574	39794.jpg	localization
+20	what disease does this image have?	there are Cardiomegaly, Pleural Effusion, Infiltration	f45c4f43-f4b1264b-8142f784-3a2cc1b8-3044d393	classification
+21	please segment the heart from the given image.	207,336,202,318,203,298,204,277,208,252,215,232,226,220,240,212,253,210,265,209,278,209,288,209,300,218,314,239,327,265,336,289,341,312,346,336,343,355,331,364,314,367,295,369,276,369,258,366,241,362,221,351,207,336,202,318,203,298,204,277	6c27223e-2af02bb2-4a4c08dc-a4a6337b-3a22f065	segmentation
+22	give the accurate bbox of Cardiomegaly	606,201,766,421	40121.jpg	localization
+23	please segment the heart from the given image.	189,377,185,358,192,337,200,315,211,293,221,273,233,262,250,256,264,256,278,258,292,260,304,262,318,271,334,291,352,315,370,335,386,355,397,377,393,398,372,413,345,418,317,421,287,419,260,415,233,408,208,395,189,377,185,358,192,337,200,315	05dcd750-5109af79-284f83d9-8e648946-c0f5192e	segmentation
+24	describe the image	bilateral lung volumes continue to remain low . there is no significant interval change in the lungs since . bilateral lower lung atelectasis, left side more than right is similar . ill-defined, coalescent opacity in the left upper lung is concerning for aspirationsinfection and requires attention on followup radiograph . endotracheal tube ends above the clavicles, approximately . cm from carina . consider advancing ett by - cm for adequate seating . ogt is seen to course below the diaphragm into the stomach however, its distal end is off the radiographic view . right internal jugular line can be traced approximately up to the level of lower svc  .	f13451af-d7719742-8d7fb7fd-43dd3145-5110ade0	report generation
+25	give the accurate bbox of Cardiomegaly	112,137,463,375	69965.jpg	localization
+26	describe the image	as compared to the previous radiograph, the monitoring and support devices are in unchanged position . known bilateral parenchymal fibrosis . the known rounded right lung mass, likely representing an old abscesses . the lung volumes have decreased, causing increased crowding of vascular and bronchial structures at the lung bases . moderate cardiomegaly persists . no overt pulmonary edema . no larger pleural effusions  .	901ae751-ecc0a5c6-805e0dde-8abe20b4-58fe8bf9	report generation
+27	describe the image	a small left pleural effusion is new . there is no focal consolidation, pneumothorax, or pulmonary edema . the cardiomediastinal silhouette is within normal limits .  . new small left pleural effusion .  . no focal consolidation, pneumothorax, or pulmonary edema  .	018996f1-cbdb8c77-c3a8dee9-f6ecefba-9f31e7a6	report generation
+28	please segment the heart from the given image.	186,360,177,341,177,320,179,296,184,272,190,249,202,235,218,228,232,225,246,225,259,226,268,228,276,237,285,257,296,281,308,300,321,318,333,338,335,357,324,368,306,375,287,382,266,385,247,384,228,381,206,373,186,360,177,341,177,320,179,296	e48a2a3c-d8eea4c0-107f5c63-387dce36-b5548570	segmentation
+29	give the accurate bbox of Cardiomegaly	158,738,509,799	36234.jpg	localization
+30	give the accurate bbox of Cardiomegaly	138,675,201,882	69530.jpg	localization
+31	describe the image	the endotracheal tube was removed and the tracheostomy tube was placed . the nasogastric tube and the right picc line are in unchanged position . unchanged appearance of the radiograph . no pneumothorax or other complications . low lung volumes . borderline size of the cardiac silhouette without pulmonary edema or pneumonia  .	d25b95b3-d66cd8a1-56f561eb-a86eb971-ee538459	report generation
+32	give the accurate bbox of Cardiomegaly	579,348,843,717	41770.jpg	localization
+33	describe the image	mild focal rightward deviation of the trachea is stable, previously reported to be due to enlarged left lobe of the thyroid . prominence of the right hilum is stable . calcification of the aortic knob is similar in appearance as compared to . slight blunting of the posterior left costophrenic angle is stable since at least and is chronic . patchy left base retrocardiac opacity has been present over multiple prior studies dating to at least and may represent scarring . the cardiac silhouette is mild to moderately enlarged . no overt pulmonary edema is seen . projecting over the posterior left th rib, is a . cm nodular opacity, which is similar in appearance compared to the radiograph from , suggesting that it is benign . grossly stable chest radiograph with perhaps slight enlargement of the cardiac silhouette, given differences in technique  .	4f0b6d4a-714f9830-411038ec-643c689d-27dbb4ef	report generation
+34	please segment the heart from the given image.	205,321,199,301,200,280,202,259,204,237,206,217,212,204,221,195,231,189,242,187,252,186,259,185,269,194,286,212,311,234,336,254,358,278,373,306,372,333,357,348,335,355,311,359,286,359,266,357,244,349,221,338,205,321,199,301,200,280,202,259	ffd4c6a4-d509d017-f42a0764-78fc37cf-a3bf7b4b	segmentation
+35	describe the image	since , small to moderate right pleural effusion and small left pleural effusion has slightly decreased in size . right basilar atelectasis is unchanged . heart size is normal . tortuous aorta is again noted . moderate hiatal hernia is identified . no evidence of focal consolidations or pneumothorax . small on the left pleural effusion . slight decrease in size of pleural effusions since  .	1273482e-957cac1c-225d74b9-1fcb5dfa-03e65820	report generation
+36	describe the image	endotracheal tube terminates approximately . cm above the carina . enteric tube courses below the level of the diaphragm, out of the field of view . right ij central venous catheter is stable position . multifocal right-sided pulmonary opacities are stable to slightly improved . left base opacity is stable . cardiac and mediastinal silhouettes are stable  .	3ed5f11c-ec7598cb-1e28d30b-a0d61992-001a7e98	report generation
+37	describe the image	there is interval development of bibasilar opacities with air bronchograms . a curvilinear lucency along the right heart border is also new and may represent pneumomediastinum effect . the remaining lung is clear . mediastinal contours are otherwise stable . no pleural effusion . no pneumothorax . the bones are diffusely sclerotic as seen on ct abdomen and pelvis from .  . new patchy bibasilar opacities could represent aspiration pneumonia in the appropriate clinical context .  . a curvilinear lucency along the right heart border may represent pneumomediastinum and repeat frontal and lateral radiographs are recommended for confirmation .  . diffusely sclerotic bones can be seen with renal osteodystrophy diffuse metastatic disease . with dr  .	5f4d2ccf-577d084d-ebe36b86-be862f1b-de477e42	report generation
+38	describe the image	a left typically directed chest tube is present . a trace left apical pneumothorax persists . slight increase in left basilar atelectasis . no pleural effusion . relative lucencies in the right lower lung zone may reflect underlying emphysematous change . the size the cardiomediastinal silhouette is within normal limits . unchanged subcutaneous gas . persisting trace left apical pneumothorax with a chest tube in place . extensive subcutaneous emphysema unchanged  .	8ed563b4-e366b541-e7d8529e-8fb563b9-588234ee	report generation
+39	describe the image	no comparison . the lung volumes are normal . mild cardiomegaly with elongation of the descending aorta . at both lung bases, left more than right, parenchymal opacities with air bronchograms are visualized . in the appropriate clinical setting . the findings could reflect pneumonia . no pulmonary edema . correct position of a right pectoral port-a-cath . mild to moderate bilateral pleural effusions are better visualized on the lateral than on the frontal view  .	24dae1f1-901af922-11bbfb2f-945fbfd4-440e8470	report generation
+40	describe the image	the heart is normal in size . there is new mild rightward shift of mediastinal structures, probably due to atelectasis in the right lower lobe with a small-to-moderate new right-sided pleural effusion . projecting over the left upper lung is a small nodular focus that is not perceptible on the prior study . possibly it reflects a prior healed fracture involving the posterolateral course of the left sixth rib, but the healed fracture was already there and otherwise unchanged, so the possibility of a pulmonary nodule projecting over the same area should be considered and excluded . there is no evidence for pleural effusion on the left . there is no pneumothorax . bony demineralization with mild degenerative changes are noted along the thoracic spine . it is difficult to compare an upper lumbar compression deformity at l with the prior study, although it can be discerned .  . new right basilar opacity with volume loss and pleural effusion . parenchymal opacification may be explained by atelectasis associated with the presence of an effusion, although an infectious etiology cannot be entirely excluded .  . small nodular focus projecting over the left upper lung . a lung nodule cannot be excluded . when clinically appropriate, short-term repeat pa and lateral radiographs are recommended to see whether the nodular focus is persistently demonstrated or chest ct evaluation could be considered  .	467759e1-0421dd28-5322afc7-1ba64779-278e8357	report generation
+41	what disease does this image have?	there are Cardiomegaly, Pleural Other, Pleural Thickening	c0eb8f9c-b404b698-4b47abf9-cea216fd-27bea26f	classification
+42	describe the image	compared to prior chest radiographs since , most recently . mild pulmonary edema is new no and mild cardiomegaly has increased . there is no pneumothorax, but pleural effusions are presumed, though not large . there has been no gross change in multiple endovascular graft in the ascending thoracic aorta  .	58ca3ca4-be119734-a61c28f9-ff9a1569-70059bc3	report generation
+43	describe the image	in comparison with the study of , there is little change . again there is substantial enlargement of the cardiac silhouette with elevated pulmonary venous pressure and bilateral pleural effusions with underlying compressive atelectasis . swan-ganz catheter tip again is in the orifice of the right pulmonary artery  .	a6d18cb6-12f2afc5-01623453-d3b4abaf-9fc7c542	report generation
+44	please segment the heart from the given image.	205,375,196,350,197,323,204,298,215,273,228,250,242,237,258,230,272,228,285,228,299,229,311,230,324,241,343,262,366,287,388,308,403,332,412,358,403,382,379,395,353,402,326,409,301,412,275,411,250,406,226,395,205,375,196,350,197,323,204,298	f56ccfaa-99efa5a1-14c02d21-c4eee720-023e4ec4	segmentation
+45	give the accurate bbox of Cardiomegaly	672,438,913,491	45484.jpg	localization
+46	describe the image	the lungs are mildly hypoinflated with focal linear left lower lobe opacity . mild vascular congestion is present . no focal opacity . no pleural effusion or pneumothorax . mild cardiomegaly with coronary stents is stable . a tortuous aorta is present . mediastinal contour and hila are unremarkable . visualized osseous structures are notable for multilevel degenerative changes of the thoracic spine with endplate sclerosis and disc space loss .  . mild vascular congestion .  . left basilar opacity is most consistent with atelectasis . if there is strong clinical suspicion for pneumonia, short-term followup radiographs may be considered  .	9b0a9a3b-85c6a8a2-d70c8ab8-d2143351-c416d930	report generation
+47	please segment the heart from the given image.	173,362,167,344,172,324,181,306,192,288,204,270,218,258,233,252,246,248,261,248,276,249,289,250,303,259,321,278,343,303,363,325,381,346,395,369,389,390,368,404,340,407,310,411,281,409,253,404,224,395,195,381,173,362,167,344,172,324,181,306	4670bd5e-2d39025b-96408399-17a2ee82-38731895	segmentation
+48	what disease does this image have?	there are Atelectasis, Pleural Other, Fibrosis, Mass	21e29187-2e837f2e-13a053c7-db465b39-10b433c2	classification
+49	describe the image	portable view of the chest demonstrates a . cm apical right pneumothorax, not definitely present on the radiograph from at pm . right subcutaneous emphysema as well as basilar atelectasis is essentially unchanged . the cardiomediastinal contour is stable . right pigtail is unchanged in position .  . cm right apical pneumothorax . otherwise, little interval change  .	ccb21ed0-ee55b247-eecd4f3a-e7efe845-98d8fa70	report generation
+50	please segment the heart from the given image.	222,340,212,323,212,303,214,283,219,260,225,239,234,225,248,216,260,212,272,210,284,209,291,209,299,216,310,234,325,256,339,274,353,294,367,314,371,334,360,345,343,352,325,360,304,362,285,363,265,361,242,354,222,340,212,323,212,303,214,283	5cae88f2-5a812378-d8831150-7d992d5d-a0093de7	segmentation
+51	describe the image	the tracheostomy is in place . there is new opacity in the left lower lung, most likely reflecting newly developed left lower lobe partial atelectasis . the left picc line tip is at the level of mid svc . the rest of the lungs are clear and there is also no change in the partially imaged cervical hardware within the limitations of this study technique  .	bafd8049-bd3a9891-f9f6b76d-f5b37bc0-ed305d1b	report generation
+52	describe the image	moderate cardiomegaly is stable . widening mediastinum has improved . bibasilar atelectasis have minimally improved . there is no evident pneumothorax . previously seen pneumoperitoneum is less conspicuous than before . left chest tube remains in place . sternal wires are aligned . patient is status post cabg and avr mildly improved bibasilar atelectasis . pneumoperitoneum is less conspicuous than before  .	e4c11f2e-5a5fe18d-6fe151d1-352b46bf-cce34d3a	report generation
+53	describe the image	the et tube tip is cm above the carina . right internal jugular line tip is at the level of mid svc . heart size and mediastinum are unchanged in appearance as well as there is no change in moderate-to-severe pulmonary edema . pleural effusions are potentially present  .	f6ab9645-d82f0b40-7ca9006c-c8e7989c-bdb8e220	report generation
+54	give the accurate bbox of Cardiomegaly	688,688,846,754	45705.jpg	localization
+55	Is Lung Lesion in this image?	no Lung Lesion.	3f467516-65239a58-6e77c17b-60a97b94-21e54b8b	classification
+56	describe the image	no focal consolidation, pleural effusion, or pneumothorax is seen . lung volumes are slightly low . heart and mediastinal contours are stable . the pulmonary vasculature is stably prominent . stable pulmonary vascular prominence  .	9ca0363e-fdff4d95-96e5096a-97f38108-92d5f30a	report generation
+57	describe the image	newly placed left pacemaker is present, with leads in the regions of the right atrium and right ventricle, with no visible pneumothorax . extensive fibrosis is present throughout the right lung with associated marked volume loss, with shift of mediastinum and heart to the right . less extensive scarring or fibrosis is present within the left lung . no pleural effusion or acute skeletal finding .  . permanent pacemaker leads in expected location of right atrium and right ventricle with no pneumothorax .  . asymmetrically distributed interstitial lung disease much worse on the right than the left . the patient carries a history of interstitial lung disease, and correlation with outside cross-sectional imaging would be helpful for a more complete characterization  .	f0d9969a-a9042f58-1736f5ba-71f731e4-f21baddc	report generation
+58	describe the image	there are new interstitial opacities and vascular congestion, most consistent with mild pulmonary edema, although an atypical infection is a consideration . a more focal consolidation at the medial right base may be related to the underlying abnormality, although focal atelectasis or developing consolidation is difficult to exclude . there is no pleural effusion or pneumothorax . the mediastinal contours are normal . the heart size is at the upper limits of normal . new intersitial abnormality with a more focal opacity at the right base . the etiology could be mild pulmonary edema with a slight asymmetric component or an atypical infection . clinical correlation is recommended  .	4ec6de74-3e43d7f1-3eb36177-924b7dc1-ebe5f3a0	report generation
+59	describe the image	the et tube, ng tube, left subclavian line are unchanged . there is increased volume loss infiltrate and both lower lobes . there remainder the appearance the chest is unchanged  .	3973f6fd-9e015ad8-10438496-faf0ed84-4435e71d	report generation
+60	give the accurate bbox of Cardiomegaly	618,634,908,761	61971.jpg	localization
+61	what is the level of effusion?	moderate	3d377c9a-a5011273-d5fe2e32-69b3cebd-7f8e7d58	classification_sev
+62	please segment the heart from the given image.	140,313,138,300,146,289,157,276,169,262,182,253,196,250,210,252,223,256,236,260,254,266,270,268,288,277,305,295,320,316,330,334,335,349,332,367,316,383,292,390,265,388,238,384,212,372,192,359,173,346,154,330,140,313,138,300,146,289,157,276	dc441240-f3c28c73-aa8604f8-c537f96d-331fb251	segmentation
+63	please segment the heart from the given image.	220,324,217,309,221,293,228,276,234,259,239,241,247,229,261,222,274,218,286,218,298,218,306,217,314,225,325,243,344,266,363,285,384,307,401,332,402,354,387,368,364,372,338,373,309,369,282,363,259,355,236,340,220,324,217,309,221,293,228,276	875bbbdf-61588d36-6509edb3-16555340-8e4c1a40	segmentation
+64	what disease does this image have?	there are Atelectasis, Cardiomegaly, Lung Opacity, Pneumonia	9abd9d64-5fe910b0-eeb95bed-c8386794-886e30dc	classification
+65	describe the image	as compared to the previous radiograph, there is little overall change . moderate cardiomegaly, nasogastric tube in situ . both left and right internal jugular vein catheter are in unchanged position . no pleural effusions . no pneumothorax . minimal fluid overload  .	735b9ec0-24fffc84-34f92eff-23d87d2f-a9e9b06e	report generation
+66	describe the image	there is a mildly tortuous thoracic aorta, with aortic arch calcifications noted . otherwise, the cardiomediastinal silhouettes are within normal limits . heart size is top-normal . the bilateral hila are unremarkable . the lungs are clear . there is no evidence of pulmonary vascular congestion . there is no pneumothorax or pleural effusion . no displaced rib fractures are seen . no acute cardiopulmonary process . no evidence of a displaced rib fracture . if rib fractures are strongly suspected, dedicated rib radiographs could be obtained to further evaluate for subtle rib fractures  .	d2ef5277-3bdbebab-099ded38-853a0f90-12332a2d	report generation
+67	give the accurate bbox of Cardiomegaly	227,392,508,522	45213.jpg	localization
+68	please segment the heart from the given image.	221,327,216,310,220,292,227,275,235,257,244,242,253,234,267,229,279,229,291,232,306,234,320,236,334,244,350,262,368,283,384,300,396,318,404,339,397,360,377,372,353,378,329,380,304,375,281,369,260,359,237,345,221,327,216,310,220,292,227,275	1981b6d8-6b861ed4-fc988463-9b885074-5e76de76	segmentation
+69	describe the image	moderate enlargement of cardiac silhouette persists . the mediastinal and hilar contours are unchanged . previous pattern of mild pulmonary vascular congestion has somewhat improved . no focal consolidation, pleural effusion or pneumothorax is seen . there are no acute osseous abnormalities . mild pulmonary vascular congestion, slightly improved in the interval  .	a10acec1-27119ee3-9d53bbc9-97aea0da-431de5d4	report generation
+70	describe the image	no appreciable change in the residual consolidation and atelectasis in the right upper lobe . heterogeneous opacification in the left mid and lower lung zone probably the residual of left aspiration pneumonia has improved slightly . presence of severe emphysema makes it difficult to distinguish among bronchiectasis, fluid-filled bullae, and lung nodules, even cavitary lung nodules . heart size is normal . there is no pleural abnormality . left pic line ends in the mid to low svc  .	74de3a39-8f77ed5d-e89ca9cf-518525a7-55ef96dd	report generation
+71	what disease does this image have?	there are Atelectasis, Consolidation, Lung Opacity, Pleural Effusion, Infiltration	9fb74ca1-7b985548-bba2331d-a53ab634-a908e168	classification
+72	give the accurate bbox of Cardiomegaly	396,684,469,898	58758.jpg	localization
+73	give the accurate bbox of Cardiomegaly	672,603,854,775	41505.jpg	localization
+74	describe the image	in comparison with study of , there is little change and no evidence of acute cardiopulmonary disease . no pneumonia, vascular congestion, or pleural effusion . again, there is an impression on the right side of the lower cervical trachea, raising the possibility of a thyroid mass  .	add69148-664fa5a2-a4791c18-395750da-3779cb2b	report generation
+75	please segment the heart from the given image.	194,346,187,326,189,305,193,284,201,261,209,239,219,226,234,217,248,214,262,213,275,213,284,214,292,224,304,242,321,263,336,281,352,299,366,318,367,339,353,352,331,362,307,371,281,375,258,374,235,371,212,362,194,346,187,326,189,305,193,284	95aa18d9-27969db3-9c904c3b-7e6eb3fa-95ee0061	segmentation
+76	describe the image	there is no evidence of post-procedure pneumothorax . enlargement of the cardiac silhouette is seen and there is diffuse prominence of interstitial markings throughout both lungs  .	d19c5030-f1f68a20-458d9dc6-29cdff73-5c5207be	report generation
+77	describe the image	diffuse bilateral pulmonary opacification developed suddenly on over a five-hour period . it improved on , and it has subsequently worsened, accompanied by substantial increase in cardiac size and in mediastinal caliber due to venous engorgement . the change over the past hours suggest volume overload or cardiogenic edema . component of widespread infection or even noncardiogenic edema may well be present concurrently . pleural effusions are presumed, but not large . there is no pneumothorax . tip of the endotracheal tube is cm from the carina and should be withdrawn mm for optimal placement . upper enteric drainage tube passes into the stomach and out of view . right internal jugular line ends low in the svc . no pneumothorax . was paged at pm  .	ecd3031d-bf9f8b5d-68f91d61-2d361729-47a22018	report generation
+78	describe the image	frontal and lateral views of the chest enteric tube is seen within the neo-esophagus, which is located posterior and right of the mediastinum . there is no significant esophageal dilation . there are no air-fluid levels . a right chest tube is unchanged . there is no pneumothorax . significant atelectasis at the right lung base is unchanged while there is improved aeration at the left lung base . a small amount of subcutaneous emphysema persists . mildly dilated, air-filled loops of large bowel are unchanged  .	4eeeec3d-73e0a4ec-8c05bc83-4b76858d-4d9a8269	report generation
+79	describe the image	no pneumothorax or appreciable pleural effusion, left upper pleural drain in place . a peripheral consolidative subpleural lesion in the left upper lobe could be residual atelectasis following retraction . followup advised . aside from bands of atelectasis, the lower lungs are clear . cardiomediastinal silhouette is a normal postoperative appearance  .	31c797eb-52584679-bd53420d-98844076-7c2fcc36	report generation
+80	give the accurate bbox of Cardiomegaly	382,434,469,607	69087.jpg	localization
+81	describe the image	as compared to the previous image, the known rib fractures of ribs on the right are less well appreciated . local pleural thickening is minimal, there is no pleural effusion . minimal retrocardiac atelectasis, minimal fluid overload but no overt pulmonary edema and no pneumonia . the clips at the level of the right hilus are constant in position  .	2e907338-3047e980-c4c3ac97-1017a254-f4718bfb	report generation
+82	describe the image	in comparison with the study of , there is increasing opacification at both bases . although some of this may represent pleural fluid, atelectasis, and even elevation of pulmonary venous pressure, superimposed aspiration or infectious pneumonia must be seriously considered in the appropriate clinical setting . some monitoring and support devices are essentially unchanged  .	e99bd057-f7bd4a6d-edc6e610-1d2fcfa0-0ebeeb16	report generation
+83	where is atelectasis?	right	d89fb578-18650497-9c0edad5-f7830af3-b1fc430a	classification_loc
+84	describe the image	comparison is made to the patients previous study dated at .  . right internal jugular port-a-cath remains in place . interval removal of the right chest tube . no pneumothorax is seen . stable appearance to the right hemithorax with lateral pleural thickening and scattered opacities suggestive of scarring . left lung remains grossly clear . no pulmonary edema . status post median sternotomy with aortic valve replacement with stable post-operative cardiac and mediastinal contours  .	50de208b-2c2f13e1-aaded5fa-05af3891-6072c1ef	report generation
+85	describe the image	in comparison with the study of , there is little overall change . areas of increased opacification are again seen in the right hemithorax . chronic changes of the left lateral ribs are again noted . port-a-cath is in unchanged position  .	f189ae4f-4d120c8d-78661df3-8bad1d7f-c1db01bc	report generation
+86	give the accurate bbox of Cardiomegaly	571,480,779,779	45756.jpg	localization
+87	give the accurate bbox of Cardiomegaly	722,683,911,788	61046.jpg	localization
+88	where is atelectasis?	base	4241de56-f62e7cd8-d1747249-c31f9cef-949d3179	classification_loc
+89	describe the image	in comparison with study of , there is increased opacification at the right base consistent with pleural effusion and collapse of the right middle and lower lobes . poor definition of the left hemidiaphragm suggests some pleural effusion and basilar atelectasis on this side . no evidence of acute focal pneumonia or vascular congestion . monitoring and support devices are essentially unchanged  .	258b4aa6-a6a4b6e6-e6efe789-c666ce8c-52665e7e	report generation
+90	give the accurate bbox of Cardiomegaly	609,556,770,706	40818.jpg	localization
+91	describe the image	persistent cardiomegaly accompanied by worsening pulmonary vascular congestion and mild-to-moderate pulmonary edema as well as enlarging right pleural effusion, now moderate in size and associated with adjacent atelectasis in the right mid and lower lung regions . focal rounded opacity lateral to the left infrahilar region may represent a focus of coalescing edema, but differential diagnosis includes focal aspiration and developing infection . attention to this region on a short-term followup radiograph is suggested  .	c4bf420a-a4d41169-ae1c53d2-34260bf6-e051cbdb	report generation
+92	please segment the heart from the given image.	232,333,228,311,225,288,225,267,230,246,236,229,245,217,256,210,267,207,278,206,293,206,309,208,327,219,346,242,362,269,373,294,380,318,382,345,372,367,353,381,331,387,310,391,291,388,273,384,257,372,241,354,232,333,228,311,225,288,225,267	5edb384c-4373a68c-3322167e-c6b995ab-c5dab57f	segmentation
+93	describe the image	the lung volumes are normal . the tip of the endotracheal tube projects cm above the carina . no complications, in particular no pneumothorax . moderate cardiomegaly . no pulmonary edema . plate-like atelectasis at the right lung bases  .	0cdbfb7e-9c8ed5dd-a7f03d0e-ee75b924-4c1ee1e6	report generation
+94	please segment the heart from the given image.	140,344,138,328,147,311,157,294,170,276,185,260,202,251,220,247,235,248,251,250,271,253,288,253,306,261,328,275,351,299,370,319,384,340,391,365,376,391,347,407,309,413,271,416,237,408,208,397,183,383,158,364,140,344,138,328,147,311,157,294	54b915e6-cf048e54-fac349a9-235c5b63-16df7641	segmentation
+95	give the accurate bbox of Cardiomegaly	154,585,455,735	58643.jpg	localization
+96	describe the image	ap portable upright and lateral views of the chest provided . there is focal fibrosis in the right upper lobe accounting for the slightly coarsened reticular opacities noted at that level . there is mild pulmonary edema which appears new from prior exam . no effusion or pneumothorax . heart is mildly enlarged . mediastinal contour appears normal . bony structures are intact . mild pulmonary edema, new from prior  .	90b55353-cf1bd40b-f3c909a4-926a03bf-83d126fe	report generation
+97	describe the image	comparison is made to previous study from . there has been mild improved aeration at the right base however, a right basilar opacity remains . there is atelectasis at the left base . there are bilateral pleural effusions, right side worse than left . a right-sided port-a-cath with the distal lead tip in the proximal svc is again seen and stable . there are no pneumothoraces . heart size is within normal limits . there is calcification in the thoracic aorta  .	4019ed41-28e1a5e7-b51c3889-db887625-72dac184	report generation
+98	give the accurate bbox of Cardiomegaly	342,539,690,729	40077.jpg	localization
+99	describe the image	extensive subcutaneous emphysema involving the entire chest and lower neck is unchanged . evaluation of the lungs is limited due to linear opacities from subcutaneous air collections . within this limitation, a small right apical pneumothorax likely persists . pleural fluid is small in amount, if any . there is increased opacification of the the right lung base, likely reflecting collapse . the cardiomediastinal contours are within normal limits . extensive pneumomediastinum is not significantly changed from .  . persistent tiny right apical pneumothorax .  . no significant change in pneumomediastinum .  . extensive subcutaneous emphysema, similar to prior exam  .	70ccf709-464d5ec0-8bfe56f7-6b0c83ca-242b636c	report generation
+100	describe the image	in comparison to the prior radiograph of day earlier, a small right pleural effusion has resolved, right upper lobe postobstructive atelectasis and consolidation have partially cleared, and platelike atelectasis in the left lower lobe has slightly improved . other findings including intrathoracic lymphadenopathy and the right chest wall mass are not appreciably changed  .	dc5186e1-893dc185-2328195c-5dc2716e-5912229f	report generation
+101	describe the image	heart size is mildly enlarged . the aorta is tortuous, unchanged and demonstrates diffuse atherosclerotic calcifications . mediastinal and hilar contours are is similar . the pulmonary vasculature is normal . streaky opacities in the lung bases likely reflect areas of atelectasis . no focal consolidation, pleural effusion or pneumothorax is present . there are multilevel degenerative changes in the thoracic spine . mild bibasilar atelectasis  .	6603cd76-6fdb394f-c20f62df-672a8ab3-06fe518c	report generation
+102	please segment the heart from the given image.	221,403,209,385,206,364,208,344,213,323,217,301,223,286,232,278,240,273,251,271,264,271,275,270,287,278,307,297,336,319,363,337,382,359,393,386,385,412,367,427,348,431,328,435,306,435,285,433,262,428,239,419,221,403,209,385,206,364,208,344	76c90030-a2037245-65dcbc3d-e76b56c7-3f502d4e	segmentation
+103	describe the image	feeding tube tip mid stomach . worsened bibasilar infiltrates . right port-a-cath in place . surgical clips upper abdomen . feeding tube in place . worsened bibasilar infiltrates  .	d66caa78-d6c77b4d-50e0e65f-5bc88d67-9590cca6	report generation
+104	give the accurate bbox of Cardiomegaly	617,577,883,728	45621.jpg	localization
+105	give the accurate bbox of Cardiomegaly	116,806,287,899	36269.jpg	localization
+106	describe the image	ap views of the chest provided . right port-a-cath ends at the upper svc . new tiny right apical pneumothorax . scarring in the right middle and right lower lobe is likely secondary to prior wedge resection and stable from ct chest . opacity in the right lung base is new from ct abdomen pelvis and likely represents rfa changes . elevation of the left hemidiaphragm and probable mild atelectasis is unchanged from . hilar and cardiomediastinal contours are normal .  . new tiny right apical pneumothorax .  . multiple pulmonary nodules are better evaluated on ct .  . right middle lobe and right lower lobe interstitial prominence may represent rfa changes, including hemorrhage  .	399d09b2-5484db65-3e1f8785-1fb0b914-25a7770c	report generation
+107	give the accurate bbox of Cardiomegaly	653,231,782,361	46986.jpg	localization
+108	describe the image	the lungs are clear without focal consolidation for effusion . there is no pneumothorax . cardiac silhouette is mildly enlarged . atherosclerotic calcifications seen at the aortic arch and there is tortuosity of the descending thoracic aorta . no acute osseous abnormalities identified . mild cardiomegaly without acute cardiopulmonary process  .	3f467516-65239a58-6e77c17b-60a97b94-21e54b8b	report generation
+109	give the accurate bbox of Cardiomegaly	341,507,702,749	69906.jpg	localization
+110	please segment the heart from the given image.	203,319,196,299,197,278,202,256,207,233,210,213,216,199,227,192,238,187,249,187,261,187,271,186,285,194,304,209,329,229,354,246,374,265,386,291,384,317,367,335,344,345,320,350,295,350,271,349,248,345,222,335,203,319,196,299,197,278,202,256	899499f3-31284d06-cd3ee149-d7161561-cfd3ac54	segmentation
+111	where is atelectasis?	left	d89fb578-18650497-9c0edad5-f7830af3-b1fc430a	classification_loc
+112	what disease does this image have?	there are Pneumonia	8b9a9d23-2143b9c9-8c1d24ca-0c6ec70e-3f35821d	classification
+113	give the accurate bbox of Cardiomegaly	176,406,366,548	41451.jpg	localization
+114	describe the image	moderate to large right pleural effusion appears similar to the recent radiograph with adjacent atelectasis andor consolidation in the mid and lower lungs . there is no definite pneumothorax . widespread airspace opacities throughout the left lung have worsened and may reflect a combination of asymmetrical edema and pulmonary infection  .	bf824d9b-58dc5387-0495e596-852aec12-a8ddebd6	report generation
+115	describe the image	frontal and a lateral chest radiographs demonstrate multiple sternotomy wires, mediastinal clips, and post cabg material . right lung base scarring and irregularity of the right rib cage may be secondary to cardiac surgery and are unchanged . moderate cardiomegaly is redemonstrated . there is no pulmonary edema, pleural effusion, pneumothorax, or focal opacity concerning for pneumonia .  . no pulmonary edema, pleural effusion, or evidence of pneumonia .  . unchanged moderate cardiomegaly and post cardiac surgery changes . these findings were communicated via telephone by dr  .	eca475ef-aead6a0e-70a5b60e-ea7e0466-c5f628e9	report generation
+116	describe the image	mild pulmonary vascular congestion is still present and could be a source of mild edema and wheezing . moderate cardiomegaly is longstanding . there is no focal consolidation or pleural effusion  .	0e38ae69-93415c3c-2ba661d0-97c9673a-c419e742	report generation
+117	describe the image	there is volume loss in the right lung with right apical pleural thickening and extensive pleural calcification . findings are likely chronic . there is minimal left apical pleuroparenchymal scarring with calcification . there is no focal consolidation in the left lung . the heart size appears within normal limits . the aorta is somewhat unfolded . bony structures appear demineralized though intact . probable chronic volume loss with scarring and pleural calcification in the right lung . no definite signs of pneumonia or chf  .	ff228045-70802ce7-ef703447-8005b59c-01731f92	report generation
+118	please segment the heart from the given image.	187,332,181,314,183,293,187,273,196,250,206,228,218,215,234,207,248,203,262,201,275,202,284,204,292,216,306,237,327,263,345,284,357,305,366,328,361,346,343,357,320,362,294,368,270,368,248,365,226,360,203,349,187,332,181,314,183,293,187,273	f4a185f1-db2de1fd-a05b274e-21f07d10-63a30841	segmentation
+119	describe the image	lungs are well expanded multifocal opacities in the lower lobes and in the lingula largest in the lingular consistent with multifocal pneumonia .  . mediastinum and hila are normal . the heart is mildly enlarged in the left heart border is obscured . a left anterior fourth rib expansile deformity may represent an old fracture although is not seen on prior examinations .  . multifocal pneumonia .  . left fourth anterior rib deformity may represent a chronic fracture although ct chest is recommended to exclude osseous malignancy . recommendations noncontrast ct of the chest is recommended for further evaluation  .	ad3e9192-2fff549b-fb3e55d8-e52b1c7d-33c62ed1	report generation
+120	give the accurate bbox of Cardiomegaly	614,485,799,799	45298.jpg	localization
+121	please segment the heart from the given image.	230,300,228,284,231,268,235,249,237,229,240,210,244,195,253,185,264,178,276,175,288,173,297,173,308,182,327,201,352,225,373,245,387,267,395,294,389,317,372,329,351,336,331,338,308,336,287,332,266,326,244,316,230,300,228,284,231,268,235,249	ff8c1776-fff321e9-3c623b70-65d0e954-a24e76aa	segmentation
+122	give the accurate bbox of Cardiomegaly	693,687,744,741	60785.jpg	localization
+123	describe the image	consolidation in the infra and supra hilar regions of the right lung has increased . whether this is atelectasis or developing pneumonia is radiographically indeterminate . moderate to severe cardiomegaly, central pulmonary vascular engorgement are chronic . small right pleural effusion has increased . there is no pneumothorax . et tube is in standard placement . nasogastric tube passes as far as the upper stomach but the tip is obscured . indwelling right internal jugular line ends in the upper right atrium  .	4fed7c61-7907de34-0de6c2e0-3be4a53b-4d3c94ed	report generation
+124	describe the image	comparison to . the patient has received a new right pectoral port-a-cath . the port-a-cath shows an unusual course, with parts of the tube looped in the internal jugular vein . repositioning of the port should be considered . scarring at the right lung basis . no pleural effusions . no pneumonia, no pulmonary edema  .	8855e943-629b8069-4513817b-abe47f54-ad77a8d6	report generation
+125	describe the image	heart size is normal . the mediastinal and hilar contours are normal . the pulmonary vasculature is normal . lungs are clear . bilateral small pleural effusions are present, . there are no acute osseous abnormalities . a small amount of free air under the right hemidiaphragm is likely related to the recent c-section procedure . no radiographic evidence of pneumonia . small bilateral pleural effusions . free intraperitoneal air is probably related to recent c-section procedure . clinical correlation suggested  .	3bb71340-2b4cbc68-465eee79-4a8d2779-0e3b05e1	report generation
+126	give the accurate bbox of Cardiomegaly	361,595,737,832	60737.jpg	localization
+127	describe the image	frontal and lateral chest radiographs again demonstrate chronic right pleural thickening and volume loss . the patient is status post wedge resections in the left lung . there is scarring in the right mid-lung as well as atelectasis at the bilateral lung bases, without definite focal consolidation . the heart is mildly enlarged . no appreciable pleural fluid or pneumothorax is identified . the visualized upper abdomen is unremarkable . no definite focal consolidation identified . bibasilar atelectasis  .	938898f3-aff4535b-2ea38818-91e2eb40-caa6ba0c	report generation
+128	where is atelectasis?	right	d21086ef-49d39bfc-e7043417-6b761232-acd6df1b	classification_loc
+129	describe the image	pa and lateral chest radiographs the cardiomediastinal and hilar contours are normal . there is a new opacity in the right upper lobe with central lucency, concerning for a cavitary lesion . in addition peribronchovascular nodular opacities are seen in both lower lobes, concerning for peribronchial spread of infection . there is no pleural effusion or pneumothorax . multifocal opacities including possible right upper lobe cavitary lesion, concerning for infection, including pyogenic bacteria and tuberculosis . recommended a ct of the chest for further assessment . findings discussed withe dr at am on  .	fdb6b9dd-208cd53f-d9b77059-9e219a68-57624012	report generation
+130	give the accurate bbox of Cardiomegaly	612,495,776,694	60804.jpg	localization
+131	describe the image	mild to moderate enlargement of the cardiac silhouette is re- demonstrated . lung volumes are decreased compared to the previous radiograph . the aorta is diffusely calcified and mildly tortuous . small bilateral pleural effusions are noted along with mild pulmonary vascular congestion . additionally more focal opacity within the retrocardiac region is concerning for an area of pneumonia though atelectasis could have a similar appearance . no pneumothorax is identified . there are multilevel mild degenerative changes in the thoracic spine . mild pulmonary vascular congestion and small bilateral pleural effusions . retrocardiac opacity may reflect pneumonia, though atelectasis may have a similar appearance  .	4ddeda2f-e8ce827f-3b891208-f8b5ce6d-73546771	report generation
+132	what is the level of effusion?	small	d89fb578-18650497-9c0edad5-f7830af3-b1fc430a	classification_sev
+133	please segment the heart from the given image.	195,359,188,336,193,312,203,288,212,264,225,244,241,232,262,227,277,226,291,231,305,236,317,240,332,254,351,276,374,302,397,323,418,346,433,371,426,396,403,414,372,420,340,421,307,416,275,409,245,398,216,382,195,359,188,336,193,312,203,288	01a10a96-48b4e1fc-da1c19c1-bfdd8727-178636fc	segmentation
+134	describe the image	slight interval improvement in patchy opacity at medial right lung base otherwise, no significant interval change . again seen is patchy retrocardiac opacity with lateralization of the left hemidiaphragm, compatible with left lower lobe collapse andor consolidation and small left effusion . hazy opacity at the right lung base laterally could reflect a small right effusion . there is upper zone redistribution and vascular plethora compatible with chf . no new infiltrate identified . the et tube tip lies . cm above the carina . ng tube tip extends beneath the diaphragm, off film . again seen is a right ij line, tip over distal svc . no pneumothorax detected . slight interval improvement in patchy opacity at medial right lung base otherwise, no significant interval change  .	9fb74ca1-7b985548-bba2331d-a53ab634-a908e168	report generation
+135	describe the image	in comparison with the study of , there is little definite change . the opacification on the left appears less prominent, though this may in large part reflect differences in technique  .	79fc296d-6c472d2b-5a982046-0e43bbd0-5c93bde0	report generation
+136	describe the image	comparison to . no relevant change . the size of the cardiac silhouette is slightly increased, but overall still in the range of normal . no pleural effusion . no pulmonary edema . no pneumonia  .	f65aedeb-7b0d874b-d4f82d35-43d4188c-e3319979	report generation
+137	please segment the heart from the given image.	185,320,179,298,183,276,187,254,192,231,196,210,201,196,211,188,221,183,234,181,245,181,253,180,263,188,280,204,303,226,327,243,347,265,361,291,361,316,345,335,320,347,293,355,267,357,244,355,224,348,202,336,185,320,179,298,183,276,187,254	996ab4ee-3c0b78e6-48830478-0d47031f-f5ee6fa5	segmentation
+138	please segment the heart from the given image.	173,331,165,308,167,281,173,256,185,231,199,207,212,192,229,182,244,177,260,174,276,173,289,174,302,186,317,208,335,234,353,259,370,286,383,316,379,344,361,365,333,378,304,385,272,385,245,379,219,371,193,352,173,331,165,308,167,281,173,256	572a3a1a-04167bad-656a0790-72d7d94c-6138230d	segmentation
+139	give the accurate bbox of Cardiomegaly	218,350,350,476	46919.jpg	localization
+140	describe the image	right upper lobe pneumonia and moderate pulmonary edema developed between and . both have improved substantially . small left pleural effusion reflects the previous cardiac decompensation . heart is normal size . right jugular line ends in the lower svc . no pneumothorax  .	0a36542b-f3753fb9-49b1eb1a-b753bab9-f41bb56e	report generation
+141	describe the image	the lung volumes are low with bibasilar moderate atelectasis with small pleural effusion . the heart contour is difficult to assess with these bibasilar changes . the upper lung is unremarkable . there is no pneumothorax . conclusion new bilateral small pleural effusion with moderate bibasilar atelectasis  .	baa4d39e-5446cb22-cb9605a4-5a6b4be3-c4f8ebb5	report generation
+142	describe the image	the ng tube tip passes below the diaphragm terminating in the stomach . the heart size and mediastinum are unchanged . bilateral pleural effusions and bibasilar atelectasis is unchanged . the pulmonary edema appears to be minimally improved since the prior study and no pneumothorax is seen  .	eaeb297a-65d1eaa2-2afbaf93-2f3726d7-56d77a4b	report generation
+143	Is Pleural Thickening in this image?	no Pleural Thickening.	5f4d2ccf-577d084d-ebe36b86-be862f1b-de477e42	classification
+144	give the accurate bbox of Cardiomegaly	257,572,478,701	59640.jpg	localization
+145	describe the image	lung volumes are appreciably lower and explaining in part what is nevertheless a substantial increase in size of moderate to large hiatus hernia . bibasilar atelectasis is worsened . upper lungs are grossly clear . heart size is difficult to assess but probably not grossly enlarged or changed . no pneumothorax  .	832a8168-ad43a2d7-70c7e117-3b34b90b-cef9c753	report generation
+146	describe the image	left-sided central venous catheter is stable in position . asymmetric right greater than left reticulonodular opacities with hilar engorgement may reflect edema less likely pneumonia . no large effusion or pneumothorax . cardiomediastinal silhouette is unchanged . mild degenerative changes of the thoracic spine are seen . findings raise concern for asymmetric pattern of pulmonary edema, less likely pneumonia  .	4949b210-6f1dde06-4b885e6e-6f82421f-ea338763	report generation
+147	describe the image	heart size and mediastinum are unchanged including mild cardiomegaly . right upper lobe opacity is most likely representing atelectasis . left lower lobe opacities are present as well as right basal opacities but appear to be improved as compared to the pet-ct within the limitation of comparison of different modalities . as compared to the chest radiograph from via opacities are slightly more pronounced and does reassessment of the patient in weeks for documentation of improvementresolution of those findings is required hyperinflation is re- demonstrated, consistent with known emphysem  .	8b3c85bb-3e4a729c-62d06086-0b5136d5-b10751aa	report generation
+148	give the accurate bbox of Cardiomegaly	100,690,205,731	55826.jpg	localization
+149	describe the image	extensive lobulated widening of the anterior superior mediastinum is highly concerning for a mass . heart size is normal . the aorta is tortuous . the pulmonary vasculature is normal . lungs are clear . no pleural effusion or pneumothorax is seen . s-shaped scoliosis of the thoracolumbar spine is present . no acute osseous abnormalities demonstrated . large anterior mediastinal mass . further assessment with contrast-enhanced ct is recommended  .	810da8a0-8a89650f-74545e4d-9cdbf128-5546f6d7	report generation
+150	give the accurate bbox of Cardiomegaly	725,752,898,842	45687.jpg	localization
+151	please segment the heart from the given image.	176,368,169,349,172,327,176,306,181,283,186,261,195,247,208,239,219,235,231,233,242,233,252,233,265,241,285,259,310,282,335,302,355,327,367,356,363,382,345,398,322,403,297,407,269,407,244,404,220,398,194,386,176,368,169,349,172,327,176,306	a0cffd98-88b3237a-60b2ba61-cd9b1d9d-04e29c0b	segmentation
+152	where is atelectasis?	right	d3a45939-1586213e-2eedfebd-da2cc78a-370d25c9	classification_loc
+153	describe the image	small-to-moderate right pneumothorax is slightly larger today than yesterday, pigtail pleural drainage catheter unchanged in position could be fissural . borderline cardiomegaly and wide mediastinum are stable . left lung shows vascular congestion suggesting borderline cardiac decompensation  .	e31e6216-931f13b3-26b38c6d-f11b88a7-36ea518e	report generation
+154	Is Enlarged Cardiomediastinum in this image?	no Enlarged Cardiomediastinum.	78b8bbb4-71c62001-9a069918-c64d8979-a9aad138	classification
+155	give the accurate bbox of Cardiomegaly	665,637,858,713	39726.jpg	localization
+156	describe the image	single portable frontal ap chest radiograph demonstrate intact median sternotomy wires, mediastinal clips, pacemaker device projecting over the left upper thoracic cavity with intact leads within the right atrium and right ventricle . persistently low lung volumes with bibasilar atelectasis with slightly increased patchy opacity within the retrocardiac region . no additional focal opacity . no pleural effusion or pneumothorax . persistent moderate cardiomegaly . limited assessment of the osseous structures are unremarkable and upper abdomen is within normal limits .  . markedly limited exam . assessment for subtle abnormalities is limited .  . increased opacity within the retrocardiac region, likely representing atelectasis however cannot exclude superimposed pneumonia in the appropriate clinical setting .  . persistent low lung volumes with bibasilar atelectasis and moderate cardiomegaly  .	9abd9d64-5fe910b0-eeb95bed-c8386794-886e30dc	report generation
+157	describe the image	the left-sided pacemaker leads terminate in the expected location of the right atrium and right ventricle . heart size and mediastinum are stable . large hiatal hernia is redemonstrated . there is no evidence of pneumothorax . lungs are essentially clear with no pleural effusion or pneumothorax seen  .	cff72cf7-a50a1717-5122f706-591182d4-3c77d70b	report generation
+158	please segment the heart from the given image.	214,333,207,312,208,289,212,264,219,238,228,216,236,203,247,195,257,192,266,193,275,194,284,194,295,203,311,222,328,247,345,269,359,293,371,321,372,346,360,360,340,366,318,369,295,367,275,366,253,360,232,349,214,333,207,312,208,289,212,264	f8ab6df5-93e49538-4d7f984d-e12e98c4-e81e88ef	segmentation
+159	what disease does this image have?	there are Lung Lesion	b0cf33fb-4440c863-fc509339-50705ed5-25f1c73b	classification
+160	describe the image	in comparison with the study of earlier in this date, there again is diffuse bilateral pulmonary opacification consistent with some degree of pulmonary edema superimposed on multifocal pneumonia . central catheter is unchanged  .	ed62e34d-d8828bdc-1073b746-e6c2dfe8-f6a7e8c1	report generation
+161	describe the image	the cardiac silhouette is mildly enlarged . the aorta is calcified and tortuous . right paratracheal opacity is stable and may relate to vascular structures without mass effect seen on the trachea . the previously seen left-sided picc is no longer seen . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . mild enlargement of the cardiac silhouette . no focal consolidation seen  .	3508823e-e70ebdb1-6d129c8e-fd2ce62d-aa09400a	report generation
+162	describe the image	bibasilar atelectasis have increased . there is no pneumothorax or pleural effusion . cardiac size is normal . ng tube tip is in the stomach . right ij catheter tip is in the cavoatrial junction  .	2e892ddf-123f06a6-66004411-2015d31a-9db8f82c	report generation
+163	what disease does this image have?	there are Enlarged Cardiomediastinum, Support Devices	f6ab9645-d82f0b40-7ca9006c-c8e7989c-bdb8e220	classification
+164	what is the level of effusion?	mild	b1906677-c8d94795-2472d990-8d174670-147006a7	classification_sev
+165	give the accurate bbox of Cardiomegaly	263,415,646,618	41141.jpg	localization
+166	describe the image	the cardiac silhouette is markedly enlarged, increased from prior underlying cardiomyopathy or pericardial effusion may be present . the aorta is calcified, indicating atherosclerosis . the mediastinal and hilar contours are normal . low lung volumes . the pulmonary vasculature is normal . there is bibasilar atelectasis . no pleural effusion or pneumothorax is seen . multilevel degenerative changes of the visualized spine . marked cardiomegaly, increased from prior, underlying cardiomyopathy or pericardial effusion may be present . no definite evidence of pulmonary edema, as clinically questioned  .	2340a874-94125650-12b0eb86-2387e61a-9c79db7c	report generation
+167	describe the image	the cardiomediastinal silhouette and hilar contours are unchanged in appearance with stable rightward mediastinal shift . again appreciated is a right dual-lumen port with the tip terminating at the cavoatrial junction . there has been slight interval improvement in the widespread parenchymal opacities particularly in the right mid and lower lung and now appears back to baseline in appearance similar to that of study . multiple nodular opacities are again seen in the left lower lung, better appreciated on recent ct torso examination . there is no new focal consolidation worrisome for infectious process . there is no pleural effusion or pneumothorax . mild improvement of right mid-to-lower lung opacities, back to baseline appearance . no new finding worrisome for pneumonia . multiple nodular opacities are better appreciated on recent ct torso examination . results were discussed over the telephone with by dr . on at time of initial review  .	2c289102-9fb4e87c-3e975af6-fb6d8db9-31c89e92	report generation
+168	please segment the heart from the given image.	201,288,195,271,195,254,199,236,205,218,211,201,217,186,228,175,238,168,247,164,259,162,271,162,288,170,310,186,333,207,353,227,370,250,382,279,380,306,366,326,340,341,314,348,285,344,262,339,240,328,218,309,201,288,195,271,195,254,199,236	1df86c6a-c5308f87-4dae24bf-5acfe642-c5e79dd4	segmentation
+169	describe the image	since the previous radiograph, the extensive right upper lobe pneumonia is constant in extent and severity . the opacities in the right lower lobe have slightly decreased in extent . there is no evidence of pneumothorax . moderate cardiomegaly with tortuosity of the thoracic aorta persists . no pleural effusions  .	eae3222e-35f3a2e6-dc9b238a-a31a67e9-49959f03	report generation
+170	please segment the heart from the given image.	198,274,189,256,187,236,192,215,197,193,202,175,209,161,221,153,234,150,247,148,260,148,275,148,295,155,321,168,346,186,364,201,377,220,384,245,376,269,356,286,330,300,303,309,279,308,261,307,240,302,218,291,198,274,189,256,187,236,192,215	6ac7fa63-a3677e51-55b6201e-0bedc5d1-33b7b3c6	segmentation
+171	please segment the heart from the given image.	211,335,203,312,205,288,213,265,224,240,233,219,243,206,253,198,263,196,275,197,290,199,302,202,313,212,328,233,347,257,364,276,379,297,388,321,381,344,362,360,339,367,317,373,295,374,275,372,254,366,230,354,211,335,203,312,205,288,213,265	f5777135-3931a213-4d086b32-244a198a-625d6d2a	segmentation
+172	describe the image	the right-sided pleural effusion has markedly decreased in size . there is a small amount of layering pleural fluid along the right lateral chest wall . heart size is within normal limits . the left lung is clear . no pneumothoraces are identified  .	2881525a-8ab828cb-1c53e547-3ed0b424-b3293a77	report generation
+173	give the accurate bbox of Cardiomegaly	513,527,874,804	70927.jpg	localization
+174	describe the image	moderate pulmonary edema is new since in this patient with moderate cardiomegaly and an atrioventricular pacemaker . there is no pneumothorax . pleural effusions are small if any . conclusion new moderate pulmonary edema  .	7d739746-29813397-34492930-04e7d18b-af5fdee9	report generation
+175	describe the image	left chest wall pacer device is again seen with leads extending to the region the right atrium and right ventricle . the heart is top-normal in size . hila appear congested . there is cephalization without frank edema . mild scarring at the left lung base is suspected . mild cardiomegaly with hilar congestion  .	95c8fa1c-e1304f19-9151c3b0-a2b87343-e45ae174	report generation
+176	describe the image	in comparison with the study of , there again is a large left pneumothorax despite a chest tube in place . the diffuse bilateral parenchymal opacification so are essentially unchanged . left subclavian picc line again extends to the lower portion of the svc  .	6a00db9c-2225a79f-f8d6eaee-f39bf897-6c2eeee1	report generation
+177	describe the image	a dual-lead left pectoral pacemaker device courses through the left transvenous approach terminating into the right atrium and right ventricle respectively . there are no lung opacities concerning for aspiration or infection . there is no pneumothorax . the heart size, mediastinal and hilar contours are normal . no evidence of pleural effusion . no lung opacities concerning for aspiration or pneumonia  .	8b9a9d23-2143b9c9-8c1d24ca-0c6ec70e-3f35821d	report generation
+178	give the accurate bbox of Cardiomegaly	804,628,879,766	59606.jpg	localization
+179	describe the image	upper lobe scarring with possible bronchiectasis, best seen on the lateral view, correlate with history of chronic lung disease . no focal consolidation, pleural effusion, or evidence of pneumothorax is seen . there is minor right upper lobe linear atelectasisscarring . the aorta is tortuous . the cardiac silhouette is not enlarged . note is made of air-distended loops of bowel in the upper abdomen . however, not well assessed . biapical thickening . upper lobe scarring with possible bronchiectasis, best seen on the lateral view, correlate with history of chronic lung disease  .	9b616afb-44f22af2-246c7686-600b66d9-322e2f0e	report generation
+180	give the accurate bbox of Cardiomegaly	670,208,858,638	39957.jpg	localization
+181	describe the image	slightly rotated positioning . portable semi-upright radiograph of the chest demonstrates slightly low lung volumes . the cardiomediastinal silhouette and pulmonary vasculature are unchanged since the prior examination, with mild to moderate cardiomegaly and slight unfolding of the aorta again noted . increased right paramediastinal density immediately below the right clavicular head likely represents artifact due to patient obliquity . no chf . there is no definite pleural effusion or pneumothorax . equivocal tiny right sided effusion . no obvious focal infiltrate and no focal consolidation is identified . no pneumonia . doubt but cannot entirely exclude a tiny right effusion . probable artifact in the right paramediastinal region due to patient obliquity . if clinically indicated, pa and lateral views of the chest could help for further assessment  .	2f8617b5-b2f1e58d-b718b044-241c1780-53c37bab	report generation
+182	give the accurate bbox of Cardiomegaly	225,352,494,690	39698.jpg	localization
+183	Is Pneumothorax in this image?	no Pneumothorax.	f88b7da2-b2c929ff-8d360ff4-3a5b218a-b4ad4640	classification
+184	describe the image	on the frontal view, with mm wide rounded opacity projects over the cardiac silhouette and the medial left ninth posterior interspace . this might correspond to a . cm elliptical opacity which on the lateral view projects over the aortic root placing the lesion in the lingula, , instead it may correspond to a cm wide opacity projecting over the lower thoracic spine . a dedicated chest ct is warranted for further evaluation . the lungs are otherwise clear . there is no pneumothorax or pleural effusion . the heart and mediastinum are within normal limits . the a chest ct is recommended to evaluate one or lung lesions, either of which could be infectious or neoplastic . recommendations a chest ct is recommended to evaluate one or lung lesions, either of which could be infectious or neoplastic . with dr  .	d0a34de8-bc20a20a-7328475e-d44ffe33-70926c2b	report generation
+185	describe the image	previous mild pulmonary edema has improved . moderate to severe relative elevation left hemidiaphragm is unchanged, and there is more atelectasis at the base of the left lung, as well as possible small left pleural effusion . moderate cardiomegaly is stable . no endotracheal or nasogastric tube seen . no pneumothorax  .	e16a055f-7dc8f13f-681a283f-312b94e3-6ac51ce8	report generation
+186	give the accurate bbox of Cardiomegaly	387,415,751,624	40003.jpg	localization
+187	Is Pleural Effusion in this image?	yes, there is Pleural Effusion.	ce3d2b57-a40db63c-9c5d6ea5-912c0e8f-49ec8d57	classification
+188	describe the image	two views of the chest demonstrate low lung volumes with resultant bronchovascular crowding and prominence of the cardiomediastinal silhouette . moderate cardiomegaly is unchanged in is accompanied by pulmonary vascular redistribution . no focal consolidation, pleural effusion, or pneumothorax is identified . there may be mild vascular congestion . the visualized upper abdomen is unremarkable . cardiomegaly and pulmonary vascular congestion  .	d3222ed6-359f37e9-bc5a4607-3a482bfc-505a8e99	report generation
+189	please segment the heart from the given image.	183,394,180,372,184,345,190,320,198,293,210,268,225,252,243,242,259,239,275,241,292,245,307,250,323,264,341,291,358,322,375,349,391,376,402,404,394,432,371,449,340,455,307,456,275,451,247,444,222,432,199,417,183,394,180,372,184,345,190,320	45912c6e-d4d515e0-ff264133-23f2ef44-185b445f	segmentation
+190	give the accurate bbox of Cardiomegaly	614,485,799,799	45298.jpg	localization
+191	describe the image	ap and lateral views of the chest provided . clips are noted in the upper abdomen . there are bilateral small pleural effusions, left greater than right . there may be associated left basal atelectasis there is mild leftward rotation of patient, limiting evaluation . atherosclerotic calcifications of the aortic knob again noted . the heart size appears grossly within normal limits . no pneumothorax is seen . bony structures appear demineralized though intact . left basal atelectasis with small bilateral effusions, left greater than right  .	ce032ad3-16095648-00e9e3b0-ae2e8438-1cb28944	report generation
+192	describe the image	the tubular opacities extending upward from the left hilus have been present with very little change since . i think this is probably a complex of dilated partially impacted bronchi . there may be other tiny impacted bronchi just inferior to it, but evaluation of all of these structures is more reliable on ct scanning . heart is top-normal size . leftward deviation of the trachea at the thoracic inlet could be due either to a large and tortuous innominate artery or right thyroid nodule  .	f88b7da2-b2c929ff-8d360ff4-3a5b218a-b4ad4640	report generation
+193	describe the image	a port-a-cath terminates in the lower superior vena cava . the cardiac, mediastinal and hilar contours appear unchanged . there is a moderate left-sided pleural effusion, similar to perhaps increase since the prior abdominal ct . however, much of the apparent left basilar opacification is associated with moderate relative elevation of the left hemidiaphragm and probably atelectasis . there is no evidence of free air . left basilar opacification suggesting pleural effusion in combination with parenchymal opacification and elevation of the left hemidiaphragm . parenchymal opacification is compatible with associated atelectasis, although it is difficult to entirely exclude a coinciding infectious process  .	86122372-ca87d0d6-59ed94de-9fbb404a-6dc16108	report generation
+194	describe the image	bilateral reticular interstitial opacities are not appreciably changed . extensive biapical pleural scarring is again noted . small bilateral pleural effusions are unchanged . the cardiomediastinal silhouette is stable . aortic calcifications are incidentally noted . no significant interval change in mild pulmonary edema with small bilateral pleural effusions  .	a2f0287d-46e317d2-cbeb12d3-68c48df7-8e0cc75f	report generation
+195	describe the image	in comparison with the study of , chronic changes are again seen at the left base with atelectasis and fibrosis . the possible area of patchy opacification at the right base appears to have substantially cleared . otherwise, little change  .	2ab243e2-25c1b78a-f134bb9b-0fa3fa2c-4e49c6cc	report generation
+196	describe the image	as compared to the previous radiograph, there is no apparent radiographic change . atelectatic changes are seen at both lung bases, but no parenchymal opacities have newly appeared . the lung nodules continue to be low . borderline size of the cardiac silhouette without pulmonary edema . no evidence of pneumothorax  .	b0cf33fb-4440c863-fc509339-50705ed5-25f1c73b	report generation
+197	describe the image	there are increasing bibasilar opacities which could reflect bibasilar pneumonia, atelectasis, or aspiration . clinical correlation is advised . there is possibly a small layering left effusion . no evidence of pulmonary edema, although the vasculature appears is slightly cephalized which suggests pulmonary venous hypertension . no pneumothorax . overall cardiac and mediastinal contours are stable  .	d8485e21-e3e5d0be-ce7c4fb1-df5572c6-d328185b	report generation
+198	describe the image	lung volumes are low . the cardiomediastinal and hilar contours are within normal limits . there is no pneumothorax, fracture or dislocation . limited assessment of the abdomen is unremarkable . an opacity at right lung base is concerning for pneumonia . no pneumothorax . an opacity at the right lung base is concerning for pneumonia  .	ad5cf5b9-5c5a824b-84dfa813-86c75b21-d842c572	report generation
+199	describe the image	there is a new small right pleural effusion tracking into a fissure . no pneumothorax is detected . heart and mediastinal contours are within normal limits with mild aortic calcification . right upper quadrant stent is noted . new right pleural effusion . findings reported to by by telephone at am . on at the time of discovery of these findings  .	8243ab82-f25dff96-58abb8b7-6a8b333f-c9991539	report generation
+200	describe the image	no focal consolidation is seen . there is minimal biapical pleural thickening . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . external jewelry overlie the lower chest . no acute cardiopulmonary process . no focal consolidation to suggest pneumonia  .	f8124b8e-e8412063-24e8252f-452e63d3-f3f48336	report generation
+201	describe the image	there is no evidence of pneumothorax . the pulmonary opacities extending from the suprahilar region on the right corresponding to the mass and associated parenchymal abnormalities on the recent ct are again present . the left lung is essentially clear . cardiomediastinal silhouette and hilar contours are unremarkable . there is no pleural effusion . continued parenchymal opacities in the right upper lobe and mediastinal mass, but no evidence of pneumothorax  .	fe94fa0b-abf43751-4de4bf65-e3d9c2f4-2d27efc7	report generation
+202	describe the image	there is moderately severe cardiomegaly . as before, the mediastinal silhouette is also quite prominent . there is patchy opacity at left greater than right bases . the differential diagnosis includes pneumonic infiltrates . there is upper zone redistribution . allowing for an under penetrated film, i doubt overt chf . no gross effusion .  . prominence of both the cardiac and mediastinal silhouettes, similar to the film from one day earlier .  . patchy opacity both bases . the differential diagnosis includes pneumonic infiltrates  .	a065c610-13da4fb1-1c670854-5b6a3ac8-b4897ea4	report generation
+203	describe the image	been no change since in moderate cardiomegaly, pulmonary vascular engorgement, and small bilateral pleural effusions . no pneumothorax  .	f45c4f43-f4b1264b-8142f784-3a2cc1b8-3044d393	report generation
+204	please segment the heart from the given image.	197,267,197,246,201,225,206,205,212,184,219,166,228,151,243,142,261,138,277,138,294,140,310,145,330,158,356,178,376,205,388,230,397,257,403,288,395,318,376,340,349,355,320,361,288,351,261,337,235,318,211,294,197,267,197,246,201,225,206,205	45912c6e-d4d515e0-ff264133-23f2ef44-185b445f	segmentation
+205	describe the image	prior cxr from . mild vascular congestion and rigth basilar opacity . early interstitial pulmonary edema . cardiomediastinal silhouette and hila are normal . there is no pleural effusion or pneumothorax . mild edema . right lower opacity might represent atelectasis or early pna  .	3b30c8d8-11489af0-59e18d5a-27921f66-656e346d	report generation
+206	describe the image	patient is status post median sternotomy with tracheostomy tube in unchanged position . left main stem bronchial stent remains in unchanged position with narrowing of the stent proximally . lung volumes remain low . heart size is accentuated due to low lung volumes but appears mildly enlarged . mediastinal contours are unchanged . bronchovascular crowding is re- demonstrated as a result of low lung volumes . patchy opacities are seen within the right lung base . additional hazy opacity within the left upper lung field appears new compared to the previous study, concerning for an area of infection . small bilateral pleural effusions are noted . no pneumothorax is seen . left lateral pleural thickening is again demonstrated . no acute osseous abnormality is detected .  . ill-defined hazy opacity in the left upper lung field as well as patchy opacity within the right lung base . findings are concerning for areas of multifocal pneumonia .  . small bilateral pleural effusions .  . left main stem bronchial stent in unchanged position, though the proximal aspect appears narrowed, new compared to the prior study  .	661500db-a770351e-c9d5c9c1-6627d73c-c9cd8925	report generation
+207	what disease does this image have?	there are Lung Opacity	79fc296d-6c472d2b-5a982046-0e43bbd0-5c93bde0	classification
+208	describe the image	ap and lateral chest radiograph lung volumes are even lower on the current examination as compared to recent prior . bilateral basilar airspace opacities persist . allowing for differences in technique and lower lung volumes, the overall severity and distribution of the opacities appear similar . there is a probable residual small left pleural effusion as well . no right effusion is seen . interstitial prominence may be related to mild superimposed edema or possibly due to bronchovascular crowding due to low lung volumes . cardiomediastinal contours are similar to prior and within normal limits . no pneumothorax is evident . lower lung volumes with persistent bibasilar opacities, likely similar to prior examination allowing for differences in technique and related to aspiration events . assessment for interval development of new consolidation is difficult due to low lung volumes and ap technique . if there is ongoing clinical concern, dedicated pa and lateral chest radiographs should be considered when the patient is clinically able  .	5cf0570c-4d2cc627-d9c55d97-594c5f64-29404774	report generation
+209	Is Cardiomegaly in this image?	yes, there is Cardiomegaly.	0e38ae69-93415c3c-2ba661d0-97c9673a-c419e742	classification
+210	describe the image	semi-upright ap view of the chest the cardiac silhouette size is markedly enlarged but unchanged . the mediastinal and hilar contours are also stable . there is no pulmonary vascular congestion, definite focal consolidation, or pleural effusion . the study is somewhat limited due to underpenetration . no pneumothorax is seen . there are no acute osseous abnormalities  .	3d850393-cdf2c482-fc727d66-0b60686a-ab39229d	report generation
+211	describe the image	-mm right mid lung nodule at the level of the second anterior interspace is unchanged since , but a -mm wide nodule inferior to that is new or substantially increased . soft tissue surrounding expansile lesion of a left middle rib laterally is thicker today than it was in . there is no pleural effusion or good evidence for central lymph node enlargement . heart size is normal  .	31aafc05-3a905b4f-b1be85dd-ebd9f2af-10a164e0	report generation
+212	describe the image	comparison is made to previous study from . no pneumothoraces are seen on either side . there is a right-sided chest tube with distal lead tip in the right apex, stable . there is a right-sided ij line with distal lead tip in the distal svc, stable . there is some increased opacity at the lung bases suggestive of atelectasis versus developing infiltrate . these are more apparent than on the prior study . there are no signs for overt pulmonary edema . heart size is within normal limits  .	6bcde513-5ccd3ed7-ba802a46-df68d71e-80bbedff	report generation
+213	Is Calcification of the Aorta in this image?	no Calcification of the Aorta.	4ddeda2f-e8ce827f-3b891208-f8b5ce6d-73546771	classification
+214	describe the image	compared with , i doubt significant interval change . again seen is asymmetric pleural thickening at the right lung apex, with apparent retraction of the minor fissure . the cardiomediastinal silhouette is unchanged . there is probably very slight upper zone redistribution, but i doubt overt chf . possible minimal blunting of the right costophrenic angle, which is not clearly changed . no focal consolidation or gross effusion is identified . the cardiomediastinal silhouette is borderline enlarged with a calcified slightly unfolded aorta, but is unchanged . incidental note is made of a probable large subchondral cyst in the left glenoid . no significant change detected compared with . right apical pleural thickening, with apparent retraction of the mild fissure, again noted . upper zone redistribution and minimal blunting of the right costophrenic angle are probably unchanged, allowing for technical differences  .	c0eb8f9c-b404b698-4b47abf9-cea216fd-27bea26f	report generation
+215	describe the image	midline sternotomy wires and a prosthetic cardiac valve are again seen . lung volumes are low with overlying ekg leads present . mild retrocardiac opacity is most consistent with atelectasis . no convincing signs of pneumonia . no large effusion or pneumothorax is seen . the cardiomediastinal and hilar contours are stable and normal . imaged osseous structures appear intact . limited study with no acute findings . probable mild retrocardiac atelectasis  .	e83219d6-f23f7073-90444487-52e69d98-28314311	report generation
+216	describe the image	left chest wall pacer device is again seen with leads extending to the region of the right atrium and right ventricle unchanged and with an intact appearance . midline sternotomy wires and mediastinal clips are again noted . the cardiomediastinal silhouette remains prominent though not significantly changed . low lung volumes limit the assessment . there is mild pulmonary edema with probable small bilateral pleural effusions . no pneumothorax . bony structures are intact . cardiomegaly, mild edema, small bilateral pleural effusions  .	18d79338-95616038-7d085721-ccd09613-27971dec	report generation
+217	what disease does this image have?	there are Lung Opacity, Pleural Thickening	ff228045-70802ce7-ef703447-8005b59c-01731f92	classification
+218	give the accurate bbox of Cardiomegaly	820,845,889,865	40466.jpg	localization
+219	give the accurate bbox of Cardiomegaly	1,614,410,861	36351.jpg	localization
+220	describe the image	right picc line tip is at the level of lower svc . cardiomediastinal silhouette is unchanged . right pleural effusion is moderate, unchanged . mild vascular congestion is demonstrated but overall no substantial change since the previous examination has been demonstrated within the chest  .	f2bb52cc-f8b6b92e-036ae63c-c4c7966a-f7f8ded5	report generation
+221	give the accurate bbox of Cardiomegaly	179,472,335,503	36386.jpg	localization
+222	describe the image	support lines and tubes are unchanged in position . cardiomediastinal silhouette is within normal limits . atelectasis versus early infiltrate at the lung bases are again seen and stable . there are no pneumothoraces . there is an unchanged small left-sided pleural effusion  .	ce3d2b57-a40db63c-9c5d6ea5-912c0e8f-49ec8d57	report generation
+223	give the accurate bbox of Cardiomegaly	253,446,467,653	70298.jpg	localization
+224	where is atelectasis?	base	f1e67a2b-5b3c6a06-0c8b035b-b3438a7b-3488d81d	classification_loc
+225	what is the level of effusion?	small	4241de56-f62e7cd8-d1747249-c31f9cef-949d3179	classification_sev
+226	describe the image	in comparison with the study of , there is increased opacification at both bases with obscuration of the hemidiaphragms, consistent with layering pleural effusions, more prominent on the right . compressive atelectasis is seen at both bases . cardiac silhouette is at the upper limits of normal in size or slightly enlarged . there may be mild pulmonary vascular congestion . little change in the appearance of the picc line  .	78b8bbb4-71c62001-9a069918-c64d8979-a9aad138	report generation
+227	Is Edema in this image?	no Edema.	2c289102-9fb4e87c-3e975af6-fb6d8db9-31c89e92	classification
+228	describe the image	mild enlargement of cardiac silhouette is re- demonstrated . the mediastinal and hilar contours are similar . minimal atherosclerotic calcifications are noted at the aortic knob . the pulmonary vasculature is normal . lungs are hyperinflated but clear without focal consolidation . minimal blunting of the costophrenic sulci posteriorly may suggest the presence of trace bilateral pleural effusions . pulmonary vasculature is normal . no pneumothorax is identified . fracture deformity of the right proximal humerus is re- demonstrated, and appears chronic . widening of the left ac joint also appears chronic, also reflects prior injury . a bb marker indicating the site of the patients tenderness is identified adjacent to the eleventh posterior rib on the right . no acutely displaced fractures are visualized in the vicinity of this marker . there is minimal deformity of the right ninth lateral rib, however this may be chronic .  . probable trace bilateral pleural effusions without other acute cardiopulmonary abnormality .  . minimal deformity of the right ninth rib may reflect a chronic fracture . otherwise, no acutely displaced fracture identified  .	2bff8963-8b6e1538-e8527d2f-ade58de0-d8733777	report generation
+229	describe the image	substantial left lower lobe atelectasis has been present without improvement since . small bilateral pleural effusions and right basal atelectasis are also present . upper lungs clear . mild cardiomegaly stable  .	01a10a96-48b4e1fc-da1c19c1-bfdd8727-178636fc	report generation
+230	what disease does this image have?	there are Lung Lesion, Lung Opacity, Pneumonia, Support Devices, Nodule	fdb6b9dd-208cd53f-d9b77059-9e219a68-57624012	classification
+231	give the accurate bbox of Cardiomegaly	823,840,892,862	69579.jpg	localization
+232	please segment the heart from the given image.	196,239,194,221,201,205,209,190,221,175,233,161,245,150,256,143,267,139,281,138,298,140,310,144,326,159,347,182,369,212,385,238,397,266,402,298,390,323,363,338,330,344,299,344,273,328,250,310,229,289,209,264,196,239,194,221,201,205,209,190	d1549654-7f54d812-b27955ba-c591bb7b-050e7f3b	segmentation
+233	what disease does this image have?	there are Atelectasis, Fracture, Pleural Other, Pleural Thickening	2e907338-3047e980-c4c3ac97-1017a254-f4718bfb	classification
+234	what is the level of effusion?	mild	f1e67a2b-5b3c6a06-0c8b035b-b3438a7b-3488d81d	classification_sev
+235	describe the image	the lungs are clear without focal consolidation . right lower lobe pulmonary opacities not well-seen on the radiograph . no pleural effusion or pneumothorax is seen . the cardiac and mediastinal silhouettes are unremarkable . no acute cardiopulmonary process . right lower lobe pulmonary opacity better evaluated on ct  .	1274eb94-543c1b23-d772528a-ddcd0a47-247d2480	report generation
+236	please segment the heart from the given image.	181,373,178,355,181,335,187,315,194,293,201,271,211,256,224,248,236,243,249,241,261,242,268,242,275,251,285,269,302,293,318,314,333,334,346,356,349,378,337,390,317,399,294,407,266,409,241,406,218,400,195,388,181,373,178,355,181,335,187,315	80321566-1d300fe2-358ad58a-98a6b6d2-d7ad6c3f	segmentation
+237	describe the image	compared to prior chest radiographs since , most recently . no pneumothorax or pleural effusion . no new mediastinal widening . right hilar elevation is chronic . morphology of atelectasis and radiation fibrosis in the perihilar right upper lung is unchanged since . heart size is normal . left lung is clea  .	21e29187-2e837f2e-13a053c7-db465b39-10b433c2	report generation
+238	give the accurate bbox of Cardiomegaly	495,115,832,714	69561.jpg	localization
+239	please segment the heart from the given image.	205,337,200,311,207,283,216,256,225,228,237,205,250,192,269,183,288,183,304,185,320,188,333,192,347,205,364,230,385,258,405,283,421,309,431,337,422,358,398,368,368,372,338,375,306,376,278,376,252,372,225,359,205,337,200,311,207,283,216,256	1534c820-a44d5232-30d7c596-ca557ed1-ef14d4ae	segmentation
+240	describe the image	compared to , there has been clearing of right lung base pneumonia . there is mild residual opacity at the right lung base . there is no pleural effusion or pneumothorax . cardiomediastinal and hilar silhouettes are normal size . interval clearing of right lung base pneumonia . mild residual opacity remains  .	b5526176-794f2b50-69e9cd74-46af33f5-7af6fe66	report generation
+241	give the accurate bbox of Cardiomegaly	99,350,387,890	70035.jpg	localization
+242	describe the image	as compared to the previous radiograph, no relevant change is noted . the tip of the intra-aortic balloon pump still projects approximately cm be low the upper most portion of the aortic arch . low lung volumes . moderate pulmonary edema and moderate cardiomegaly persist . no pleural effusions . no new parenchymal opacities  .	43e99db3-f3af69aa-1bef89af-2a616e36-06724139	report generation
+243	please segment the heart from the given image.	239,375,231,353,231,333,234,313,240,290,245,267,255,251,269,241,282,237,296,239,312,243,329,246,348,258,369,279,389,304,409,321,427,338,436,360,428,387,407,410,380,424,352,431,326,429,302,425,280,413,257,396,239,375,231,353,231,333,234,313	01013130-37245f33-69b5b534-c3a80a06-afdc5f86	segmentation
+244	describe the image	new moderate right pleural effusion, small left pleural effusion, increased severe cardiomegaly, and mild pulmonary edema since . median sternotomy wires are intact and well aligned . unchanged appearance of aortic valve . no pneumothorax .  . new moderate right pleural effusion, small left pleural effusion, increased severe cardiomegaly, and mild pulmonary edema compatible with acute chf exacerbation . with dr . on the at pm, minutes after discovery of the findings  .	5b6c29ad-01d31ae3-e4640aa6-7d91c986-0dbf50a0	report generation
+245	what is the level of effusion?	normal	de36817b-ddad9d90-93b0dde7-7d2a7084-959bfaf1	classification_sev
+246	please segment the heart from the given image.	179,291,177,278,183,265,188,249,193,234,199,219,209,209,223,204,235,201,248,201,261,201,270,202,280,210,294,226,314,247,335,261,355,276,371,291,372,306,355,317,329,324,301,332,271,331,245,327,220,320,195,307,179,291,177,278,183,265,188,249	d9e5a0e8-8aea0769-56254528-f398b3f8-0632f522	segmentation
+247	what disease does this image have?	there are Pleural Effusion	3bb71340-2b4cbc68-465eee79-4a8d2779-0e3b05e1	classification
+248	please segment the heart from the given image.	218,362,212,343,214,321,215,299,219,276,224,255,233,242,249,235,264,233,276,233,288,233,298,234,308,242,321,260,338,284,354,303,372,323,387,344,390,365,377,375,355,380,332,385,307,388,283,388,259,386,235,378,218,362,212,343,214,321,215,299	b08fe095-2565dfd7-5595ad15-95b14449-410edec9	segmentation
+249	describe the image	previous mild pulmonary edema has almost resolved . heterogeneous opacification in the infrahilar right lower lung could be residual edema and atelectasis or early pneumonia . pleural effusion on the right is small if any . heart size top normal . nasogastric feeding tube ends in the stomach . right pic line ends close to the anticipated location of the superior cavoatrial junction . no pneumothorax  .	de880f21-daf4e54a-111cfbf6-376cad2a-44db77fc	report generation
+250	Is Pneumomediastinum in this image?	no Pneumomediastinum.	baa4d39e-5446cb22-cb9605a4-5a6b4be3-c4f8ebb5	classification
+251	describe the image	compared to chest radiographs since , most recently one . right pic line has been withdrawn to the low svc . previous hyperinflation indicates that severe severity of see emphysema . interstitial edema is mild . heart size normal . no focal consolidation or appreciable pleural abnormality  .	bab28dec-473a69a7-0342830f-225ecf53-892b967d	report generation
+252	describe the image	a left-sided cardiac aicd is partially imaged . the patient has had prior median sternotomy with valve replacement . a tracheostomy tube remains in place . a right-sided picc line terminates in the low svc . lung volumes are low, and there is no appreciable change in left lung airspace opacities most likely corresponding to pulmonary edema . left basilar is retrocardiac airspace opacification is most likely due to stable left lower lobe subsegmental atelectasis . right lower lobe collapse is unchanged . moderate cardiomegaly despite the projection is unchanged . a small layering left pleural effusion is unchanged . no significant interval change in mild pulmonary edema, left basilar subsegmental atelectasis, right lower lobe collapse and a small layering left pleural effusion . stable moderate cardiomegaly  .	00532124-8907bbe6-f9b22989-466f1214-1fc1866f	report generation
+253	please segment the heart from the given image.	203,340,199,322,200,301,203,281,209,259,215,239,224,227,238,220,249,217,258,216,268,216,279,216,294,224,314,243,337,268,358,288,372,313,378,342,369,365,349,377,328,380,306,381,283,378,262,374,242,367,219,355,203,340,199,322,200,301,203,281	94c76656-a3b1ad8a-5f764321-e6c1cd68-ae910284	segmentation