You can create a project with this instruction.
You are a professional radiologist helping me diagnose the patient.
I cannot supply you with the patient’s CT scan.
But I have a dedicated feature-describing tool at my disposal that takes two parameters, location and resolution, and which will return a detailed description of the image centered at that location, with a field of view of 20 times the resolution.
e.g., inspect {"location": "heart apex", "resolution": "2mm"} could return “healthy heart” or “abnormal myocardium”.
Can you give a diagnosis by first reasoning what the disease could be and, therefore, the areas you want to look into to support or rule out that disease?
You can give at max 10 inspect calls at once.
I will give you the initial finding:
Case 1
USER
The patient is found to have many scattered, high-intensity sparkles at the bottom of the left lung.
Thought
Response
Based on “many scattered high-intensity sparkles” in the left lower lung, the two broad possibilities are:
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True parenchymal or pleural high-attenuation foci—e.g., calcified granulomas from prior infection (TB, histo), pulmonary alveolar microlithiasis, talc or other inhaled dust (pneumoconiosis), or metastatic/ dystrophic calcification.
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Artifacts or extrapulmonary sources—tiny metallic fragments in the chest wall, motion, beam-hardening from ribs or surgical material.
To narrow this, we need to know:
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Are similar sparkles present elsewhere (other lobes, opposite lung, pleura, mediastinum)?
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Do they follow lymphatic routes (subpleural and peribronchovascular), suggest inhalational disease?
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Is there associated lymph node or pleural calcification (supports healed granulomatous infection)?
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Is there any airway wall thickening, masses, or soft-tissue reaction around the foci?
Below are 10 targeted “inspect” queries (20x FOV of resolution) that should answer those questions. I kept resolution at 2 mm to balance detail and coverage; feel free to adjust if your tool prefers another step size.
inspect {"location": "left lower lobe posterior-basal parenchyma", "resolution": "2mm"}
inspect {"location": "left lower lobe lateral-basal parenchyma", "resolution": "2mm"}
inspect {"location": "left costophrenic pleura (diaphragmatic dome)", "resolution": "2mm"}
inspect {"location": "left hilar lymph nodes", "resolution": "2mm"}
inspect {"location": "aortopulmonary window lymph nodes", "resolution": "2mm"}
inspect {"location": "right lower lobe posterior-basal parenchyma", "resolution": "2mm"}
inspect {"location": "left upper lobe apicoposterior parenchyma", "resolution": "2mm"}
inspect {"location": "left segmental bronchi in lower lobe", "resolution": "2mm"}
inspect {"location": "left 8th–10th ribs anterior cortex", "resolution": "2mm"}
inspect {"location": "posterior parietal pleura adjacent to T8 vertebral body", "resolution": "2mm"}Once we have those descriptions, we can correlate the pattern and decide whether the “sparkles” are intrapulmonary calcifications, dust deposits, artifacts, or something else—and reach a firm diagnosis or plan the next step.
Case 2
USER
The patient is found to have one round blob with a 2cm diameter located near the left lung apex.
Thought
Response
Step-wise reasoning toward a likely diagnosis. A solitary
round 2 cm focus in the left upper lobe apex can represent a spectrum that ranges from entirely benign to highly aggressive.
Key possibilities are:
| Broad category | Typical clues you can extract from the CT | Why it matters |
|---|---|---|
| Benign granuloma (TB, histoplasmosis, etc.) | Dense, central or “popcorn” calcification; sharply defined, smooth margin; satellite nodules | Very common in upper lobes; management is conservative if confidently benign. |
| Hamartoma | Fat and/or popcorn calcification inside the nodule | Benign; no surgery needed. |
| Primary lung cancer (early adenocarcinoma, squamous, small cell) | Lobulated or spiculated margin, “ground glass” part-solid areas, pleural retraction, associated lymphadenopathy | Potentially curable at 2 cm; staging dictates resection vs. SBRT. |
| Superior sulcus (“Pancoast”) tumor | Apex location plus chest wall/1st-2nd rib or brachial plexus invasion, thickened pleura | Requires multimodality therapy; prognosis depends on invasion. |
| Metastasis | Often multiple nodules; smooth margins; may cavitate (e.g., squamous cell head and neck) | Alters staging completely if the primary is known. |
| Focal organizing pneumonia, round atelectasis | ”Comet tail” vessels curving into lesion, pleural attachment, volume loss | Benign inflammatory; usually treated medically. |
Because the lesion sits at the apex and is only 2 cm, the main branch points are:
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Benign vs. malignant internal architecture (fat, calcification, ground glass, cavitation).
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Chest wall / pleural invasion (raises concern for a very early Pancoast tumor).
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Regional nodal or distant disease (distinguishes isolated nodule from metastasis).
High-Yield CT Queries to Sort These Out
Below are 8 inspect calls (well under the limit of 10) that together sample the nodule itself, its immediate surroundings, and the typical first “spread” stations. Use them exactly as written; adjust resolution later if you need a wider or tighter field of view.
| # | Suggested inspect call | Rationale |
|---|---|---|
| 1 | inspect {"location": "left lung apex nodule center", "resolution": "0.5mm"} | Highest-detail look at internal composition (fat, calcification, air, ground glass) |
| 2 | inspect {"location": "left lung apex nodule margin", "resolution": "0.3mm"} | Characterize edge (smooth vs. lobulated vs. spiculated) and any pleural tags |
| 3 | inspect {"location": "adjacent visceral pleura at nodule", "resolution": "0.5mm"} | Detect subtle pleural thickening or retraction (early chest wall invasion) |
| 4 | inspect {"location": "first rib head and left T1 vertebral body", "resolution": "1mm"} | Look for cortical erosion or marrow replacement suggesting Pancoast invasion |
| 5 | inspect {"location": "left hilar (station 10L) lymph nodes", "resolution": "2mm"} | Gauge regional nodal enlargement or necrosis |
| 6 | inspect {"location": "left paratracheal (station 4L) lymph nodes", "resolution": "2mm"} | Mediastinal nodes—important for staging primary lung cancer |
| 7 | inspect {"location": "right lung apex", "resolution": "2mm"} | Search for contralateral apical granulomas/metastases (benign mimic or stage IV spread) |
| 8 | inspect {"location": "left lung lower lobe posterior segment", "resolution": "2mm"} | Sampling for additional nodules; round atelectasis often basilar but helps exclude multiplicity |
How the Results Will Steer Management
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Benign pattern (fat or heavy central calcification, no spiculation, no nodes): likely hamartoma or healed granuloma → routine surveillance.
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Smooth but non-calcified nodule with no invasion/nodes: indeterminate SPN → PET-CT and/or CT follow-up 3-6 months.
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Spiculated/lobulated nodule, no clear invasion, but nodes ≥ 10 mm: probable stage T1b N1/N2 lung cancer → tissue biopsy and/or surgical planning.
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Any chest wall or rib erosion: early Pancoast → MRI brachial plexus for resectability, oncology referral.
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Multiple nodules across lobes or both lungs: metastasis or miliary infection → look for extrathoracic primary or infection labs.
Run these eight queries, share the textual outputs, and we can refine the differential or suggest the next imaging or biopsy step accordingly.