Epic Patient API MCP Server

SPRINGFIELD IMAGING CENTER CT Chest, Abdomen, and Pelvis with IV Contrast Patient: Robert Chen MRN: MRN003 Date of Exam: November 18, 2024 Ordering Provider: Dr. Michael Anderson Indication: Disease restaging - rising tumor markers, new abdominal pain COMPARISON: Prior CT dated July 12, 2024 TECHNIQUE: CT of the chest, abdomen, and pelvis was performed following administration of intravenous contrast. FINDINGS: CHEST: Lungs: Previously identified bilateral pulmonary nodules have slightly increased in size. Largest right lower lobe nodule now measures 1.3 cm (previously 1.0 cm). Several smaller nodules also show minimal interval growth. Heart: Normal size. No pericardial effusion. Mediastinum: No significant lymphadenopathy. Pleura: Trace bilateral pleural effusions, new since prior study. ABDOMEN: Liver: PROGRESSION OF METASTATIC DISEASE. Previously identified hepatic metastases have increased in size and number since July imaging. Segment 7 lesion now measures 4.5 cm (previously 2.8 cm at nadir), representing 60% increase. Multiple new sub-centimeter lesions identified throughout both hepatic lobes. Total of 15+ discrete lesions now identified compared to 8 on prior imaging. Liver is enlarged with span of 20 cm in midclavicular line. Spleen: Mildly enlarged at 14 cm. Pancreas, Adrenals: Unremarkable. Kidneys: Normal enhancement bilaterally. Colon: Sigmoid wall thickening stable compared to prior studies. Port-a-cath remains in appropriate position. Peritoneum: NEW SMALL-VOLUME ASCITES in pelvis and perihepatic regions. No discrete peritoneal nodules identified. Lymph Nodes: Sigmoid mesenteric lymph nodes slightly increased compared to prior, largest now 1.5 cm (previously 1.2 cm). PELVIS: Free fluid in pelvis as noted above. No pelvic masses. BONES: No new osseous lesions. No suspicious lytic or blastic lesions identified. IMPRESSION: 1. PROGRESSIVE DISEASE after initial partial response to first-line chemotherapy. 2. Significant progression of hepatic metastases with increase in size and number. Segment 7 lesion increased 60% (2.8 cm → 4.5 cm). Multiple new liver lesions. 3. Slight progression of bilateral pulmonary nodules. 4. New small-volume ascites - likely malignant. 5. New trace bilateral pleural effusions. 6. Disease progression occurring approximately 4 months after best response in July. RECOMMENDATIONS: Findings indicate treatment failure with first-line FOLFOX regimen. Recommend consideration of second-line chemotherapy regimen or clinical trial enrollment. Consider paracentesis with cytology if ascites increases or symptomatic. Close clinical follow-up recommended. Radiologist: Dr. Thomas Richardson, MD Board Certified Diagnostic Radiology Date Signed: November 18, 2024