db; if (! $db->tableExists('radiology_ultrasound_template')) { CLI::write('Table radiology_ultrasound_template does not exist. Skipping.', 'red'); return; } $now = date('Y-m-d H:i:s'); // --------------------------------------------------------------------- // 1. Ensure Charge Services exist in `hc_items` // --------------------------------------------------------------------- $services = [ // X-Ray (itype = 3) ['itype' => 3, 'desc' => 'X-RAY CHEST PA VIEW', 'amount' => 350.00], ['itype' => 3, 'desc' => 'X-RAY CHEST AP VIEW', 'amount' => 350.00], ['itype' => 3, 'desc' => 'X-RAY BOTH KNEE JOINTS AP & LATERAL', 'amount' => 500.00], ['itype' => 3, 'desc' => 'X-RAY LS SPINE AP & LATERAL', 'amount' => 600.00], ['itype' => 3, 'desc' => 'X-RAY CERVICAL SPINE AP & LATERAL', 'amount' => 550.00], ['itype' => 3, 'desc' => 'X-RAY ABDOMEN ERECT (KUB)', 'amount' => 450.00], ['itype' => 3, 'desc' => 'X-RAY PNS (WATER\'S VIEW)', 'amount' => 400.00], ['itype' => 3, 'desc' => 'X-RAY PELVIS WITH BOTH HIPS AP', 'amount' => 500.00], // CT-Scan (itype = 4) ['itype' => 4, 'desc' => 'NCCT HEAD / BRAIN', 'amount' => 1800.00], ['itype' => 4, 'desc' => 'NCCT HEAD (STROKE PROTOCOL)', 'amount' => 2000.00], ['itype' => 4, 'desc' => 'HRCT CHEST / THORAX', 'amount' => 2500.00], ['itype' => 4, 'desc' => 'CECT WHOLE ABDOMEN & PELVIS', 'amount' => 4500.00], ['itype' => 4, 'desc' => 'NCCT KUB (KIDNEYS, URETERS, BLADDER)', 'amount' => 2200.00], ['itype' => 4, 'desc' => 'CECT CHEST', 'amount' => 3500.00], ['itype' => 4, 'desc' => 'NCCT CERVICAL / LUMBAR SPINE', 'amount' => 2500.00], // MRI (itype = 2) ['itype' => 2, 'desc' => 'MRI BRAIN (PLAIN STUDY)', 'amount' => 4000.00], ['itype' => 2, 'desc' => 'MRI BRAIN (STROKE / DWI PROTOCOL)', 'amount' => 4500.00], ['itype' => 2, 'desc' => 'MRI LUMBOSACRAL (LS) SPINE', 'amount' => 4200.00], ['itype' => 2, 'desc' => 'MRI CERVICAL SPINE', 'amount' => 4200.00], ['itype' => 2, 'desc' => 'MRI KNEE JOINT (RIGHT / LEFT)', 'amount' => 4500.00], ['itype' => 2, 'desc' => 'MRI WHOLE SPINE SCREENING', 'amount' => 5500.00], ['itype' => 2, 'desc' => 'MRI SHOULDER JOINT', 'amount' => 4500.00], ]; $chargeIdMap = []; if ($db->tableExists('hc_items')) { foreach ($services as $svc) { $existing = $db->table('hc_items') ->where('itype', $svc['itype']) ->where('idesc', $svc['desc']) ->get(1) ->getRowArray(); if (! empty($existing['id'])) { $chargeIdMap[$svc['desc']] = (int) $existing['id']; } else { $db->table('hc_items')->insert([ 'itype' => $svc['itype'], 'idesc' => $svc['desc'], 'amount' => $svc['amount'], 'amount_r' => 0.00, 'echs_sr_no' => 0, 'update_date' => $now, 'last_update_desc' => 'Seeded by RadiologyTemplatesSeeder', ]); $chargeIdMap[$svc['desc']] = (int) $db->insertID(); } } } // --------------------------------------------------------------------- // 2. Master Templates List // --------------------------------------------------------------------- $templates = [ // ================================================================= // X-RAY TEMPLATES (Modality = 3) // ================================================================= [ 'template_name' => 'X-RAY CHEST PA VIEW (Normal)', 'title' => 'X-Ray Chest PA View', 'keywords' => 'chest, pa view, lungs, heart, normal, thorax, pulmonary, rib cage', 'Modality' => 3, 'service_key' => 'X-RAY CHEST PA VIEW', 'Findings' => <<TRACHEA & MEDIASTINUM : Trachea is central in position. Mediastinum shows normal configuration with no shift or widening.

CARDIAC SILHOUETTE : Heart size is within normal limits. Cardio-thoracic ratio (CTR) is less than 0.5. Aortic knuckle appears unremarkable.

LUNG PARENCHYMA : Both lung fields are clear with normal bronchovascular arborization. No focal parenchymal consolidation, mass, cavitation, or active infiltration seen.

HILAR REGIONS : Bilateral hilar shadows are normal in size, density, and configuration with no evidence of lymphadenopathy.

COSTOPHRENIC & CARDIOPHRENIC ANGLES : Both CP and cardiophrenic angles are acute, clear, and sharp. No evidence of pleural effusion or pleural thickening.

DIAPHRAGMS : Both domes of diaphragm are smooth, convex, and normal in position.

BONES & SOFT TISSUES : Visualized thoracic rib cage, clavicles, and soft tissues appear unremarkable. No focal bone erosion or fracture identified.

HTML , 'Impression' => 'Normal study of Chest (PA View). No active cardiopulmonary lesion detected.', 'impression_cat' => 0, ], [ 'template_name' => 'X-RAY CHEST PA VIEW - Pneumonia / Consolidation', 'title' => 'X-Ray Chest PA View - Pneumonia', 'keywords' => 'chest, pneumonia, consolidation, air bronchogram, fever, cough, opacity', 'Modality' => 3, 'service_key' => 'X-RAY CHEST PA VIEW', 'Findings' => <<TRACHEA & MEDIASTINUM : Trachea is central with no significant mediastinal shift.

CARDIAC SILHOUETTE : Cardiac size is within normal limits for age.

LUNG PARENCHYMA : Patchy inhomogeneous airspace opacity with air bronchograms noted in the right mid and lower lung zones, suggestive of consolidation. The left lung field appears clear with normal bronchovascular markings.

COSTOPHRENIC ANGLES : Mild blunting of the right costophrenic angle noted, likely reactive minimal pleural fluid. The left costophrenic angle is clear and sharp.

DIAPHRAGMS : Right dome of diaphragm is partially obscured by the overlying lower lobe opacity. Left dome is smooth and normal in contour.

BONES & SOFT TISSUES : Visualized thoracic skeleton and surrounding soft tissues are unremarkable.

HTML , 'Impression' => "Features suggestive of Right Middle and Lower Lobe Pneumonia with minimal reactive pleural effusion.\nAdvice: Clinical correlation, sputum examination, and follow-up after antibiotic therapy.", 'impression_cat' => 1, ], [ 'template_name' => 'X-RAY BOTH KNEE JOINTS AP & LATERAL - Osteoarthritis', 'title' => 'X-Ray Both Knee Joints AP and Lateral View', 'keywords' => 'knee, osteoarthritis, joint space narrowing, osteophytes, pain, arthritis', 'Modality' => 3, 'service_key' => 'X-RAY BOTH KNEE JOINTS AP & LATERAL', 'Findings' => <<JOINT SPACES : Narrowing of the medial tibiofemoral joint space noted bilaterally (Right > Left). Lateral tibiofemoral joint space is relatively preserved.

SUBCHONDRAL BONE : Subchondral sclerosis and flattening noted along the medial tibial plateau bilaterally.

OSTEOPHYTES : Marginal osteophytes seen along the femoral and tibial condylar articular margins.

PATELLOFEMORAL COMPARTMENT : Patellofemoral joint space shows mild narrowing with small patellar spurs.

LIGAMENTS & SOFT TISSUES : Visualized soft tissues around the knee joint appear normal. No radiopaque loose body or chondrocalcinosis seen.

BONE INTEGRITY : No fracture, dislocation, or lytic destructive bone lesion identified.

HTML , 'Impression' => "Bilateral Knee Osteoarthritis with medial compartment predominance (Grade II-III Kellgren-Lawrence changes).\nAdvice: Clinical correlation and orthopedic consultation.", 'impression_cat' => 1, ], [ 'template_name' => 'X-RAY LS SPINE AP & LATERAL - Lumbar Spondylosis', 'title' => 'X-Ray Lumbosacral (LS) Spine AP & Lateral View', 'keywords' => 'spine, lumbar, ls spine, back pain, spondylosis, osteophytes, disc reduction', 'Modality' => 3, 'service_key' => 'X-RAY LS SPINE AP & LATERAL', 'Findings' => <<ALIGNMENT & CURVATURE : Mild straightening of the normal lumbar lordosis noted, likely due to paravertebral muscle spasm. No spondylolisthesis or scoliosis seen.

VERTEBRAL BODIES : Vertebral body heights and bony architecture are maintained. Marginal osteophytic lipping noted along anterior and lateral borders of L3, L4, and L5 vertebrae.

INTERVERTEBRAL DISC SPACES : Reduced intervertebral disc spaces noted at L4-L5 and L5-S1 levels with mild vacuum phenomenon / subchondral sclerosis.

POSTERIOR ELEMENTS : Pedicles, laminae, and facet joints appear unremarkable. No lytic defect in pars interarticularis.

SACROILIAC JOINTS : Both sacroiliac joints are clear with preserved joint spaces.

PREVERTEBRAL TISSUES : Pre- and paravertebral soft tissue shadows are within normal limits.

HTML , 'Impression' => "Features suggestive of Lumbar Spondylosis with L4-L5 and L5-S1 disc degenerative disease.\nAdvice: MRI Lumbosacral Spine recommended for radicular symptoms or neural canal evaluation.", 'impression_cat' => 1, ], [ 'template_name' => 'X-RAY CERVICAL SPINE AP & LATERAL (Normal / Spondylosis)', 'title' => 'X-Ray Cervical Spine AP & Lateral View', 'keywords' => 'cervical, neck pain, c-spine, spondylosis, radiculopathy, disc space', 'Modality' => 3, 'service_key' => 'X-RAY CERVICAL SPINE AP & LATERAL', 'Findings' => <<ALIGNMENT : Normal cervical lordosis is mildly straightened (likely muscle spasm). Atlantoaxial alignment is normal.

VERTEBRAL BODIES : Vertebral body heights and densities are preserved. No bone destruction or compression fracture seen.

DISC SPACES : Mild reduction of C5-C6 intervertebral disc space noted with small anterior marginal osteophytes. Remaining disc spaces are preserved.

NEURAL FORAMINA & FACETS : Neural foramina and facet joints are within normal limits.

SOFT TISSUES : Prevertebral soft tissue thickness is normal at all levels.

HTML , 'Impression' => "Features suggestive of Mild Cervical Spondylosis at C5-C6 level with muscle spasm.\nAdvice: Clinical correlation.", 'impression_cat' => 1, ], [ 'template_name' => 'X-RAY ABDOMEN ERECT (Plain KUB / Acute Abdomen)', 'title' => 'X-Ray Abdomen Erect (KUB)', 'keywords' => 'abdomen erect, air fluid levels, gas, bowel obstruction, perforation, kub, calculus', 'Modality' => 3, 'service_key' => 'X-RAY ABDOMEN ERECT (KUB)', 'Findings' => <<BOWEL GAS PATTERN : Normal bowel gas distribution seen throughout small and large intestines. No pathologically dilated bowel loops.

AIR-FLUID LEVELS : No step-ladder air-fluid levels seen to suggest dynamic intestinal obstruction.

SUBDIAPHRAGMATIC AIR : No free air (crescent of gas) seen beneath either dome of the diaphragm (no pneumoperitoneum).

URINARY TRACT (KUB) : No radiopaque shadow or calculus identified along the anatomical course of the kidneys, ureters, or bladder.

PSOAS & FAT LINES : Bilateral psoas shadows and properitoneal fat lines are crisp and well preserved.

SKELETON : Visualized lumbar spine, pelvis, and rib cage show no gross bony abnormality.

HTML , 'Impression' => 'Normal Plain X-Ray Abdomen (Erect View). No evidence of bowel obstruction, perforation, or radiopaque calculus.', 'impression_cat' => 0, ], [ 'template_name' => 'X-RAY PNS WATER\'S VIEW - Sinusitis', 'title' => 'X-Ray Paranasal Sinuses (PNS - Water\'s View)', 'keywords' => 'pns, water view, sinuses, maxillary, headache, sinusitis, polyps', 'Modality' => 3, 'service_key' => 'X-RAY PNS (WATER\'S VIEW)', 'Findings' => <<MAXILLARY SINUSES : Mucosal thickening and mucosal haziness noted in the bilateral maxillary antra (Right > Left). No distinct air-fluid level or polypoid mass seen.

FRONTAL & ETHMOID SINUSES : Frontal and ethmoidal sinuses appear normally pneumatized and aerated.

NASAL SEPTUM & TURBINATES : Mild deviation of the nasal septum (DNS) noted towards the left with compensatory hypertrophy of the right inferior turbinate.

BONY WALLS : Bony margins of all visualized paranasal sinuses are intact without cortical erosion.

HTML , 'Impression' => "Features suggestive of Bilateral Maxillary Sinusitis (Right > Left) with Mild DNS.\nAdvice: ENT correlation.", 'impression_cat' => 1, ], // ================================================================= // CT-SCAN TEMPLATES (Modality = 4) // ================================================================= [ 'template_name' => 'NCCT HEAD / BRAIN (Normal)', 'title' => 'Non-Contrast CT (NCCT) Head / Brain', 'keywords' => 'ct head, brain, normal, stroke, trauma, headache, ncct, ventricles', 'Modality' => 4, 'service_key' => 'NCCT HEAD / BRAIN', 'Findings' => <<TECHNIQUE : Non-contrast axial CT sections of the brain were obtained from the base of the skull to the vertex without intravenous contrast.

BRAIN PARENCHYMA : Both cerebral hemispheres, cerebellum, and brainstem show normal attenuation and preserved grey-white matter differentiation. No focal hypo- or hyperdense lesions noted. No evidence of acute intra-axial or extra-axial hemorrhage.

VENTRICULAR SYSTEM : Lateral, third, and fourth ventricles are normal in size, shape, and position for age. No hydrocephalus.

BASAL CISTERNS & SULCI : Basal cisterns, cortical sulci, and sylvian fissures are well visualized and symmetrical.

MIDLINE STRUCTURES : Midline structures are central; no midline shift or herniation seen.

SELLA & POSTERIOR FOSSA : Sella, parasellar regions, and cerebellopontine angles are unremarkable.

CALVARIUM & ORBITS : Calvarial bones, skull base, orbits, and visualized paranasal sinuses show no fracture or gross pathology.

HTML , 'Impression' => 'Normal Non-Contrast CT Scan of the Brain. No acute intracranial hemorrhage, mass lesion, or midline shift.', 'impression_cat' => 0, ], [ 'template_name' => 'NCCT HEAD - Acute Ischemic Infarct', 'title' => 'NCCT Head - Acute Ischemic Infarct', 'keywords' => 'ct head, infarct, ischemic stroke, mca, paralysis, weakness, hypodensity', 'Modality' => 4, 'service_key' => 'NCCT HEAD (STROKE PROTOCOL)', 'Findings' => <<TECHNIQUE : Non-contrast volumetric CT of the brain performed under acute stroke protocol.

FOCAL LESION : Ill-defined, wedgeshaped area of parenchymal hypodensity noted involving the cortex and subcortical white matter of the left / right middle cerebral artery (MCA) territory.

MASS EFFECT : Associated local sulcal effacement and mild loss of insular ribbon sign / grey-white differentiation noted. No significant midline shift or compression of lateral ventricle.

HEMORRHAGE : No hyperdense area seen to suggest intracranial hemorrhage or hemorrhagic transformation.

POSTERIOR FOSSA : Cerebellum, brainstem, and posterior fossa cisterns appear unremarkable.

BONES & CISTERNS : Calvarial bones and visualized sinuses are intact.

HTML , 'Impression' => "Features suggestive of Acute Non-Hemorrhagic Ischemic Infarct in the Left / Right MCA territory.\nAdvice: Urgent neurological evaluation, MRI Brain with DWI, and MR Angiography.", 'impression_cat' => 1, ], [ 'template_name' => 'HRCT CHEST / THORAX (Normal)', 'title' => 'High Resolution Computed Tomography (HRCT) Thorax', 'keywords' => 'hrct chest, thorax, lungs, covid, interstitial, fibrosis, ggo, bronchiectasis', 'Modality' => 4, 'service_key' => 'HRCT CHEST / THORAX', 'Findings' => <<TECHNIQUE : High-resolution thin-section volumetric CT scan of the thorax was performed from lung apices to diaphragm during full inspiratory breath-hold.

AIRWAYS : Trachea and major bronchi are normal in caliber, course, and branching pattern. No endobronchial lesion or bronchiectasis seen.

LUNG PARENCHYMA : Both lung fields show normal parenchymal attenuation. No evidence of ground-glass opacities (GGO), consolidation, nodule, mass, or cavitation. Interlobular septa and bronchovascular interstitium are unremarkable. No honeycombing or reticulation.

PLEURAL SPACES : Bilateral pleural spaces are clear. No pneumothorax, pleural effusion, or thickening noted.

MEDIASTINUM & HILA : Mediastinum and hilar structures are normal. No significant mediastinal, hilar, or axillary lymphadenopathy seen.

CARDIOVASCULAR : Heart size, ascending/descending aorta, and pulmonary trunk are within normal limits.

CHEST WALL & BONES : Visualized thoracic skeleton, sternum, ribs, and soft tissues of the chest wall appear normal.

HTML , 'Impression' => 'Normal HRCT Thorax study. No active parenchymal infiltration, interstitial lung disease (ILD), or lymphadenopathy.', 'impression_cat' => 0, ], [ 'template_name' => 'CECT WHOLE ABDOMEN & PELVIS (Normal)', 'title' => 'Contrast Enhanced CT (CECT) Whole Abdomen and Pelvis', 'keywords' => 'cect abdomen, pelvis, liver, kidney, pancreas, spleen, contrast, ct abdomen', 'Modality' => 4, 'service_key' => 'CECT WHOLE ABDOMEN & PELVIS', 'Findings' => <<TECHNIQUE : Contrast-enhanced helical CT of the whole abdomen and pelvis was acquired after administration of non-ionic IV contrast.

LIVER : Normal in size and shape with homogenous parenchymal enhancement. No focal intrahepatic mass, cyst, or abscess. Intrahepatic biliary radicles (IHBR) and common bile duct are normal.

GALLBLADDER : Well distended with normal, uniform wall enhancement. No radiopaque calculus or pericholecystic collection seen.

PANCREAS : Normal in size, lobulation, and enhancement throughout head, body, and tail. Main pancreatic duct is not dilated. Peripancreatic fat planes are preserved.

SPLEEN : Normal in size, configuration, and enhancement. No focal lesion.

ADRENALS & KIDNEYS : Bilateral adrenals are normal. Both kidneys are normal in size, shape, and position with prompt symmetrical nephrogram and excretion. Corticomedullary differentiation is preserved. No calculus, hydronephrosis, or mass.

URINARY BLADDER & PELVIS : Urinary bladder is well distended with smooth walls. Internal pelvic organs are normal for age.

GASTROINTESTINAL TRACT : Stomach and small/large bowel loops show normal caliber, wall thickness, and mucosal enhancement. No bowel obstruction.

VESSELS & LYMPH NODES : Abdominal aorta, IVC, and portal vein are patent. No retroperitoneal, mesenteric, or pelvic lymphadenopathy. No ascites.

HTML , 'Impression' => 'Normal Contrast-Enhanced CT (CECT) of Whole Abdomen and Pelvis. No focal pathology, organomegaly, or lymphadenopathy.', 'impression_cat' => 0, ], [ 'template_name' => 'NCCT KUB - Ureteric / Renal Calculus', 'title' => 'Non-Contrast CT (NCCT) Kidneys, Ureters, and Bladder (KUB)', 'keywords' => 'ncct kub, stone, calculus, kidney stone, ureteric stone, hydronephrosis, colic', 'Modality' => 4, 'service_key' => 'NCCT KUB (KIDNEYS, URETERS, BLADDER)', 'Findings' => <<TECHNIQUE : Non-contrast helical CT scan of the abdomen and pelvis obtained from top of kidneys to pubic symphysis.

KIDNEYS : Both kidneys are normal in size, shape, and anatomical position. Right kidney measures ~... cm and left kidney measures ~... cm. No focal parenchymal mass lesion.

CALCULUS & HYDRONEPHROSIS : A dense radiopaque calculus measuring approximately ... mm (CT density ~ ... HU) is noted in the proximal / mid / distal right / left ureter. Associated mild-to-moderate upstream hydroureter and hydronephrosis seen with mild perinephric fat stranding.

CONTRALATERAL SYSTEM : Contralateral kidney and ureter are unremarkable without calculus or hydronephrosis.

URINARY BLADDER : Moderately distended with uniform contents. No calculus or focal wall thickening seen at the vesicoureteric junctions.

BONES & SOFT TISSUES : Visualized lumbosacral skeleton and pelvic bones appear unremarkable.

HTML , 'Impression' => "Features suggestive of a ... mm Calculus in the Right / Left Ureter causing mild-to-moderate upstream hydronephrosis and hydroureter.\nAdvice: Urology consultation and management.", 'impression_cat' => 1, ], // ================================================================= // MRI TEMPLATES (Modality = 2) // ================================================================= [ 'template_name' => 'MRI BRAIN (PLAIN STUDY - Normal)', 'title' => 'MRI Brain (Plain Study)', 'keywords' => 'mri brain, normal, head, t1, t2, flair, dwi, stroke, seizure, headache', 'Modality' => 2, 'service_key' => 'MRI BRAIN (PLAIN STUDY)', 'Findings' => <<TECHNIQUE : Multiplanar, multisequence MRI of the brain was performed on high-field system using T1WI, T2WI, FLAIR, Diffusion Weighted Imaging (DWI/ADC), and Gradient Echo (GRE/SWI) sequences.

CEREBRAL PARENCHYMA : Both cerebral hemispheres show normal sulcation, gyration, and grey-white matter differentiation. No focal area of altered signal intensity noted in the cerebral cortex, subcortical white matter, or deep grey nuclei.

DIFFUSION & HEMORRHAGE : No area of restricted diffusion on DWI/ADC to suggest acute ischemic infarction or cytotoxic edema. No blooming artifact on GRE/SWI sequences to suggest acute or chronic intracranial hemorrhage.

BRAINSTEM & CEREBELLUM : Brainstem (midbrain, pons, medulla) and both cerebellar hemispheres appear normal in morphology and signal characteristics.

VENTRICLES & CISTERNS : Ventricular system, basal cisterns, and sylvian fissures are normal in size, shape, and configuration for age. Midline structures are central.

SELLA & CRANIAL NERVES : Sella, pituitary gland, optic chiasm, and bilateral CP angles are within normal limits.

CALVARIUM & SINUSES : Visualized calvarial marrow and paranasal sinuses show normal signal intensity.

HTML , 'Impression' => 'Normal MRI Brain Study. No evidence of acute ischemia, hemorrhage, mass effect, or demyelinating lesion.', 'impression_cat' => 0, ], [ 'template_name' => 'MRI LUMBOSACRAL (LS) SPINE - Disc Herniation / Sciatica', 'title' => 'MRI Lumbosacral (LS) Spine', 'keywords' => 'mri spine, ls spine, lumbar, disc bulge, herniation, sciatica, radiculopathy, stenosis', 'Modality' => 2, 'service_key' => 'MRI LUMBOSACRAL (LS) SPINE', 'Findings' => <<TECHNIQUE : Multiplanar MRI of the lumbosacral spine performed in T1W, T2W, and STIR sagittal and axial sequences.

CURVATURE & ALIGNMENT : Mild straightening of the normal lumbar lordosis noted, consistent with paravertebral muscle spasm. Vertebral body alignment is preserved without listhesis.

VERTEBRAL BODIES : Vertebral body heights are maintained. No acute compression fracture, bone marrow edema, or focal marrow infiltration seen on STIR.

L4-L5 LEVEL : Shows diffuse disc bulge with a central/paracentral posterior disc protrusion compromising the anterior epidural space and indenting the thecal sac. Mild narrowing of bilateral neural foramina with abutment of traversing L5 nerve roots.

L5-S1 LEVEL : Shows mild diffuse posterior disc bulge with preserved neural exit foramina and no significant canal compromise.

OTHER DISC LEVELS : L1-L2, L2-L3, and L3-L4 intervertebral disc spaces and disc hydration are well preserved.

SPINAL CORD & CAUDA EQUINA : Conus medullaris ends normally at the L1-L2 level with normal signal intensity. Cauda equina nerve roots are normal in distribution.

PARASPINAL TISSUES : Visualized facet joints, posterior elements, and paraspinal soft tissues are unremarkable.

HTML , 'Impression' => "Features suggestive of L4-L5 Central/Paracentral Disc Protrusion causing thecal sac indentation and bilateral neural foraminal narrowing with nerve root abutment. Associated Lumbar Spondylodisco-degenerative changes.\nAdvice: Clinical and neurological correlation.", 'impression_cat' => 1, ], [ 'template_name' => 'MRI CERVICAL SPINE - Cervical Spondylosis', 'title' => 'MRI Cervical Spine', 'keywords' => 'mri c-spine, cervical, neck pain, disc protrusion, myelopathy, cord compression', 'Modality' => 2, 'service_key' => 'MRI CERVICAL SPINE', 'Findings' => <<TECHNIQUE : Multiplanar MRI of the cervical spine acquired in sagittal T1WI, T2WI, STIR, and axial T2WI sequences.

ALIGNMENT : Straightening of normal cervical lordosis noted, suggestive of muscle spasm. Craniocervical junction is normal.

VERTEBRAE & MARROW : Vertebral body heights and alignment are maintained. No evidence of fracture or marrow replacing lesion.

C5-C6 LEVEL : Shows posterior disc-osteophyte complex with left paracentral disc herniation indenting the anterior thecal sac and narrowing the left neural foramen with abutment of exiting left C6 nerve root.

C6-C7 LEVEL : Shows mild diffuse disc bulge without significant thecal sac indentation.

CERVICAL CORD : Cervical spinal cord is normal in caliber throughout its course with uniform signal intensity. No focal T2/STIR hyperintensity to suggest compressive myelopathy, syrinx, or demyelination.

SOFT TISSUES : Prevertebral and posterior paraspinal soft tissues are normal.

HTML , 'Impression' => "Features suggestive of Cervical Spondylosis with C5-C6 Posterior Disc Herniation causing left neural foraminal narrowing and root impingement.\nNo compressive cervical myelopathy.", 'impression_cat' => 1, ], [ 'template_name' => 'MRI KNEE JOINT - Meniscal & Ligament Assessment', 'title' => 'MRI Knee Joint (Right / Left)', 'keywords' => 'mri knee, acl, pcl, meniscus, tear, knee pain, effusion, cartilage, ligament', 'Modality' => 2, 'service_key' => 'MRI KNEE JOINT (RIGHT / LEFT)', 'Findings' => <<TECHNIQUE : Multiplanar MRI of the knee joint was performed using PD, PD-FS, T1WI, and T2-GRE sequences in coronal, sagittal, and axial planes.

MEDIAL MENISCUS : Grade II intrameniscal linear hyperintensity seen in the posterior horn of the medial meniscus, not extending to the superior or inferior articular surfaces (suggestive of intrasubstance degeneration without tear).

LATERAL MENISCUS : Anterior and posterior horns of the lateral meniscus show normal triangular morphology and uniform low signal intensity. No tear seen.

CRUCIATE LIGAMENTS : Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) show normal course, thickness, and signal intensity. Fibers are continuous and intact.

COLLATERAL LIGAMENTS : Medial Collateral Ligament (MCL) and Lateral Collateral Ligament complex (LCL) are intact with normal appearances.

EXTENSOR MECHANISM : Quadriceps tendon and patellar tendon show normal signal intensity. Patellofemoral cartilage is preserved.

JOINT EFFUSION & BONE MARROW : Mild joint effusion noted in the suprapatellar pouch. No subchondral bone marrow edema or osteochondral defect noted in femoral condyles or tibial plateau.

HTML , 'Impression' => "Grade II Degenerative Signal Change in the Posterior Horn of the Medial Meniscus.\nMild knee joint effusion. Intact ACL, PCL, and collateral ligaments.", 'impression_cat' => 1, ], [ 'template_name' => 'MRI WHOLE SPINE SCREENING (Normal)', 'title' => 'MRI Whole Spine Screening', 'keywords' => 'mri whole spine, screening, metastasis, cord, sagittal t2, stir, normal spine', 'Modality' => 2, 'service_key' => 'MRI WHOLE SPINE SCREENING', 'Findings' => <<TECHNIQUE : Sagittal T2WI and STIR screening images of the entire spine from craniocervical junction to coccyx.

CURVATURE & ALIGNMENT : Normal cervical, thoracic, and lumbar spinal curvatures and vertebral alignment are preserved.

VERTEBRAL BODIES : Vertebral body heights and marrow signal intensities are normal across all levels. No focal bone destruction, collapse, or STIR marrow hyperintensity to suggest metastasis or trauma.

DISC SPACES : Intervertebral disc heights and signals are generally preserved with early mild degenerative disc dehydration at L4-L5 and L5-S1 levels. No gross disc herniation or spinal canal stenosis.

SPINAL CORD : Spinal cord shows normal caliber and signal intensity throughout cervical and thoracic regions. Conus medullaris terminates normally at L1 level.

PARASPINAL TISSUES : Pre- and paravertebral soft tissues are unremarkable.

HTML , 'Impression' => 'Normal MRI Whole Spine Screening study. No focal marrow infiltrative lesion, vertebral collapse, or spinal cord compression.', 'impression_cat' => 0, ], ]; // --------------------------------------------------------------------- // 3. Upsert Templates into `radiology_ultrasound_template` // --------------------------------------------------------------------- $insertedCount = 0; $updatedCount = 0; foreach ($templates as $tpl) { $chargeId = 0; if (! empty($tpl['service_key']) && isset($chargeIdMap[$tpl['service_key']])) { $chargeId = $chargeIdMap[$tpl['service_key']]; } $existing = $db->table('radiology_ultrasound_template') ->where('template_name', $tpl['template_name']) ->where('Modality', $tpl['Modality']) ->get(1) ->getRowArray(); $data = [ 'template_name' => $tpl['template_name'], 'title' => $tpl['title'], 'keywords' => $tpl['keywords'], 'Modality' => $tpl['Modality'], 'charge_id' => $chargeId, 'Findings' => $tpl['Findings'], 'Impression' => $tpl['Impression'], 'impression_cat' => $tpl['impression_cat'], ]; if (! empty($existing['id'])) { $db->table('radiology_ultrasound_template') ->where('id', $existing['id']) ->update($data); $updatedCount++; } else { $db->table('radiology_ultrasound_template')->insert($data); $insertedCount++; } } CLI::write("Radiology Templates Seeding Complete!", 'green'); CLI::write(" - Charge Services Verified/Added: " . count($chargeIdMap)); CLI::write(" - Templates Inserted: {$insertedCount}"); CLI::write(" - Templates Updated: {$updatedCount}"); CLI::write(" - Total Templates: " . (count($templates))); } }