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Chest X-Ray Analysis Example

This example demonstrates Apolo's dual-level explainable approach to analyzing a chest X-ray. Follow the workflow from image input to description generation (Stage 1) to diagnostic reasoning (Stage 2).

Chest X-Ray Example

Sample chest X-ray used for analysis

Stage 1: Apolo-Vision (Description Generation)

The Apolo-Vision module analyzes the image and generates a detailed, objective description of all visible features, without making diagnostic claims.

Description Output
Prompt Used

Radiologic Image Descriptive Report

Examination: Chest Radiograph, Frontal (PA) View
Patient Position: Upright
Clinical Indication: Not Provided

Technique/Image Quality: Adequate exposure and penetration. The patient is properly positioned with good inspiration. No significant rotation is evident. All relevant anatomical structures are visualized.

Findings:

  • Lungs and Pleura:
    • The lung fields show overall increased opacity in the lower zones bilaterally, with a subtle reticular pattern visible, more pronounced at the bases.
    • Patchy areas of increased opacity in the right mid to lower lung field, featuring air bronchograms.
    • No visible pneumothorax.
    • Small blunting of the right costophrenic angle, suggesting minimal pleural fluid.
    • Left costophrenic angle appears preserved.
  • Cardiac Silhouette and Mediastinum:
    • The cardiac silhouette appears mildly enlarged with a cardiothoracic ratio of approximately 0.55.
    • The mediastinal contour appears within normal limits.
    • The aortic knob is visible and mildly prominent.
  • Hila:
    • The hila appear prominent bilaterally, with increased vascular markings.
  • Bony Structures:
    • The visualized bony structures show no gross abnormalities.
    • Mild degenerative changes in the thoracic spine.
  • Soft Tissues:
    • The soft tissues are unremarkable.
  • Other Findings:
    • No visible medical devices, foreign bodies, or surgical hardware are noted within the chest.

Descriptive Summary (Non-Diagnostic):
Frontal chest radiograph demonstrating patchy opacities in the right mid to lower lung field with air bronchograms. Mild bibasilar reticular opacities. Small right-sided costophrenic angle blunting. Mild cardiomegaly (CTR ~0.55). Prominent hilar vascular markings bilaterally. The upper lung fields appear relatively clearer.

Prompt Used for Stage 1

Generate a highly detailed, objective, non-diagnostic description of the following medical image:

Image Type: Chest Radiograph (X-ray)
View: Frontal (PA)
Key Structures to Describe: Lungs, Pleura, Cardiac Silhouette, Mediastinum, Hila, Bony Structures, Soft Tissues

Instructions:
1. Analyze systematically by anatomical region, providing comprehensive detail about visible features
2. Include precise observations about each key structure
3. Do NOT include any diagnostic conclusions, differential diagnoses, or management recommendations
4. Structure in a standard radiologic format with appropriate sections and subsections
5. Include a descriptive summary at the end that remains purely objective

Format your response as a markdown report with appropriate headings and bullet points.

Stage 2: Apolo-Dx (Diagnostic Reasoning)

The Apolo-Dx module receives only the textual description from Stage 1. It performs diagnostic classification and provides explicit reasoning steps.

<think>

I need to analyze the radiologic description of a chest X-ray to determine the most likely diagnosis. Let me extract the key findings from the provided description and reason through them systematically.

Key Findings From Description:

  1. Lungs/Pleura:
    • Patchy opacities in right mid to lower lung field with air bronchograms
    • Bilateral increased opacity in lower zones with subtle reticular pattern at bases
    • Small blunting of right costophrenic angle (suggesting minimal pleural fluid)
    • No pneumothorax
  2. Cardiac/Mediastinum:
    • Mildly enlarged cardiac silhouette (CTR ~0.55)
    • Aortic knob mildly prominent
    • Normal mediastinal contour
  3. Other:
    • Prominent bilateral hilar vascular markings
    • Upper lung fields relatively clearer
    • Mild degenerative changes in thoracic spine
    • No devices or foreign bodies

Diagnostic Reasoning:

The most significant findings are the right-sided patchy opacities with air bronchograms and the small right-sided pleural effusion. The presence of air bronchograms within the opacity is highly characteristic of air-space (alveolar) consolidation, which is most commonly seen in pneumonia. The distribution (right mid to lower zone) is also typical for a community-acquired pneumonia.

Supporting features for pneumonia:

  • Well-defined area of airspace opacity
  • Presence of air bronchograms
  • Unilateral predominance
  • Small associated pleural effusion

Additional findings to consider:

  • The mild cardiomegaly (CTR ~0.55) suggests possible underlying cardiac issues, though this could be chronic
  • Bilateral basal reticular opacities could represent some underlying interstitial changes, atelectasis, or early pulmonary edema
  • Prominent hilar vascular markings may suggest pulmonary vascular congestion

Differential considerations:

  • Primary: Right middle/lower lobe pneumonia (bacterial most likely)
  • Secondary: Mild heart failure contributing to the basal changes and possibly small pleural effusion
  • Less likely: Pulmonary infarct (typically wedge-shaped and often without air bronchograms)

Conclusion: The imaging findings are most consistent with right-sided pneumonia, likely involving the lower lobe and possibly the middle lobe, with a small parapneumonic effusion. There are also signs suggestive of mild cardiac enlargement which could represent a separate or contributing condition.

</think>

Prediction: Right-sided pneumonia (lower/middle lobe) with small parapneumonic effusion (Probability: 0.92)