pulmonary tuberculosis chest x-ray findings

tuberculosis hilar lymphadenopathy chest xray primary TB

miliary tuberculosis chest xray millet seed pattern

pleural effusion tuberculosis chest xray

mkdir -p /tmp/workspace/tb-xray-pdf/images && ls /tmp/workspace/

cd /tmp/workspace/tb-xray-pdf && python3 -c " import urllib.request import os images = [ ('01_apical_infiltrate.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_036cde593a8811b2ea82fd95f8af5ee4a5c5b605db0b533db277c88adb7239da.jpg'), ('02_cavitation.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_036cde593a8811b2ea82fd95f8af5ee4a5c5b605db0b533db277c88adb7239da.jpg'), ('03_cavity_airfluid.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_4dbe84955206a8e0df67d401cbef5b4bbd372e65fda0fcc4b650ce9366c2df1c.jpg'), ('04_tree_in_bud.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0bfecf8207d727505bdad55d1a9bee816a57654ec0166c056cb6ce7459a8853a.jpg'), ('05_bilateral_infiltrates.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5731433f093f995f2ec4949020c20f50064272fe1fbc40c755858e26d135d651.jpg'), ('06_calcified_nodes.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_376bf3501c6a4838baf851ab72acecb2492efb3adf181a57bd69a5f53e494b71.jpg'), ('07_hilar_lymphadenopathy.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_41ce37d16fd67c570a06d6c5aee7f66207c85d664fe280a84423ab1bf4ac3add.jpg'), ('08_pleural_effusion.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_253f5d324eae7de1b615c41034709e75f1b098c98006818b1f039a3a92687b34.jpg'), ('09_miliary_tb.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_65a3833b903656187d64c033e345c27ab09b9f0dee4a63db4ecac138d3128651.jpg'), ('10_pneumatocele.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5644c1928d10e2d7502f0ea79fdcc64fc3c13b8f5873b8f71d2d41c939028434.jpg'), ] headers = {'User-Agent': 'Mozilla/5.0'} for fname, url in images: req = urllib.request.Request(url, headers=headers) with urllib.request.urlopen(req, timeout=20) as r: data = r.read() with open(f'images/{fname}', 'wb') as f: f.write(data) print(f'Downloaded {fname} ({len(data)} bytes)') print('All done') "

cd /tmp/workspace/tb-xray-pdf && python3 << 'PYEOF' from PIL import Image, ImageDraw, ImageFont import os # Each entry: (filename, annotations) # annotation types: 'circle' (x%, y%, r%, color, label), 'arrow' (x1%,y1%,x2%,y2%, color, label), 'rect' (x%,y%,w%,h%, color, label) # All coordinates as fraction of image width/height (0.0-1.0) findings = [ { 'file': 'images/01_apical_infiltrate.jpg', 'out': 'images/01_annotated.jpg', 'annotations': [ {'type': 'rect', 'x': 0.52, 'y': 0.03, 'w': 0.35, 'h': 0.28, 'color': (255,80,80), 'label': 'Apical Infiltrate (RUL)'}, {'type': 'arrow', 'x1': 0.82,'y1': 0.25,'x2': 0.70,'y2': 0.15, 'color': (255,220,0), 'label': 'Cavity'}, ] }, { 'file': 'images/02_cavitation.jpg', 'out': 'images/02_annotated.jpg', 'annotations': [ {'type': 'circle', 'x': 0.68, 'y': 0.14, 'r': 0.09, 'color': (255,80,80), 'label': 'Thick-walled Cavity'}, {'type': 'rect', 'x': 0.52, 'y': 0.03, 'w': 0.35, 'h': 0.28, 'color': (255,165,0), 'label': 'Upper Lobe Consolidation'}, ] }, { 'file': 'images/03_cavity_airfluid.jpg', 'out': 'images/03_annotated.jpg', 'annotations': [ {'type': 'circle', 'x': 0.30, 'y': 0.20, 'r': 0.10, 'color': (255,80,80), 'label': 'Apical Cavity'}, {'type': 'arrow', 'x1': 0.10,'y1': 0.28,'x2': 0.25,'y2': 0.25, 'color': (255,220,0), 'label': 'Air-Fluid Level'}, {'type': 'rect', 'x': 0.05, 'y': 0.55, 'w': 0.30, 'h': 0.20, 'color': (0,200,255), 'label': 'Bronchogenic Spread'}, ] }, { 'file': 'images/04_tree_in_bud.jpg', 'out': 'images/04_annotated.jpg', 'annotations': [ {'type': 'rect', 'x': 0.05, 'y': 0.10, 'w': 0.40, 'h': 0.35, 'color': (255,80,80), 'label': 'Consolidation + Cavity (LUL)'}, {'type': 'circle', 'x': 0.22, 'y': 0.65, 'r': 0.12, 'color': (0,255,120), 'label': 'Tree-in-Bud Pattern'}, {'type': 'arrow', 'x1': 0.50,'y1': 0.65,'x2': 0.32,'y2': 0.65, 'color': (255,220,0), 'label': 'Centrilobular Nodules'}, ] }, { 'file': 'images/05_bilateral_infiltrates.jpg', 'out': 'images/05_annotated.jpg', 'annotations': [ {'type': 'rect', 'x': 0.50, 'y': 0.02, 'w': 0.38, 'h': 0.38, 'color': (255,80,80), 'label': 'Right Upper Lobe Infiltrate + Cavity'}, {'type': 'rect', 'x': 0.12, 'y': 0.02, 'w': 0.32, 'h': 0.22, 'color': (255,165,0), 'label': 'Left Apical Opacity'}, {'type': 'rect', 'x': 0.10, 'y': 0.30, 'w': 0.35, 'h': 0.30, 'color': (0,200,255), 'label': 'Left Mid-Zone Fibronodular Shadows'}, ] }, { 'file': 'images/06_calcified_nodes.jpg', 'out': 'images/06_annotated.jpg', 'annotations': [ {'type': 'circle', 'x': 0.48, 'y': 0.38, 'r': 0.08, 'color': (255,220,0), 'label': 'Calcified Hilar Nodes'}, {'type': 'circle', 'x': 0.55, 'y': 0.28, 'r': 0.07, 'color': (255,220,0), 'label': 'Mediastinal Calcification'}, {'type': 'rect', 'x': 0.60, 'y': 0.72, 'w': 0.28, 'h': 0.12, 'color': (0,200,255), 'label': 'Blunted Costophrenic Angle (Effusion)'}, {'type': 'rect', 'x': 0.10, 'y': 0.72, 'w': 0.28, 'h': 0.12, 'color': (0,200,255), 'label': 'Blunted Costophrenic Angle'}, ] }, { 'file': 'images/07_hilar_lymphadenopathy.jpg', 'out': 'images/07_annotated.jpg', 'annotations': [ {'type': 'circle', 'x': 0.55, 'y': 0.42, 'r': 0.10, 'color': (255,80,80), 'label': 'Right Hilar Widening'}, {'type': 'circle', 'x': 0.40, 'y': 0.45, 'r': 0.08, 'color': (255,165,0), 'label': 'Left Hilar Adenopathy'}, {'type': 'rect', 'x': 0.15, 'y': 0.08, 'w': 0.28, 'h': 0.22, 'color': (0,200,255), 'label': 'Left Apical Infiltrate'}, ] }, { 'file': 'images/08_pleural_effusion.jpg', 'out': 'images/08_annotated.jpg', 'annotations': [ {'type': 'rect', 'x': 0.05, 'y': 0.60, 'w': 0.40, 'h': 0.32, 'color': (0,200,255), 'label': 'Pleural Effusion (Meniscus Sign)'}, {'type': 'rect', 'x': 0.05, 'y': 0.10, 'w': 0.40, 'h': 0.40, 'color': (255,80,80), 'label': 'Left Upper Lobe Consolidation'}, {'type': 'arrow', 'x1': 0.55,'y1': 0.75,'x2': 0.38,'y2': 0.80, 'color': (255,220,0), 'label': 'Blunted CP Angle'}, ] }, { 'file': 'images/09_miliary_tb.jpg', 'out': 'images/09_annotated.jpg', 'annotations': [ {'type': 'rect', 'x': 0.05, 'y': 0.05, 'w': 0.42, 'h': 0.88, 'color': (255,80,80), 'label': 'Miliary Nodules (Left Lung)'}, {'type': 'rect', 'x': 0.52, 'y': 0.05, 'w': 0.42, 'h': 0.88, 'color': (255,165,0), 'label': 'Miliary Nodules (Right Lung)'}, {'type': 'circle', 'x': 0.30, 'y': 0.45, 'r': 0.07, 'color': (255,220,0), 'label': '1-3mm Nodules'}, ] }, { 'file': 'images/10_pneumatocele.jpg', 'out': 'images/10_annotated.jpg', 'annotations': [ {'type': 'circle', 'x': 0.62, 'y': 0.22, 'r': 0.10, 'color': (0,255,120), 'label': 'Thin-walled Pneumatocele'}, {'type': 'circle', 'x': 0.72, 'y': 0.35, 'r': 0.08, 'color': (0,255,120), 'label': 'Thin-walled Cyst'}, {'type': 'rect', 'x': 0.10, 'y': 0.20, 'w': 0.35, 'h': 0.55, 'color': (255,165,0), 'label': 'Residual Fibrosis & Scarring'}, ] }, ] def draw_arrow(draw, x1, y1, x2, y2, color, width=3): draw.line([(x1,y1),(x2,y2)], fill=color, width=width) import math angle = math.atan2(y2-y1, x2-x1) arrow_len = 18 a1 = (x2 - arrow_len*math.cos(angle-0.4), y2 - arrow_len*math.sin(angle-0.4)) a2 = (x2 - arrow_len*math.cos(angle+0.4), y2 - arrow_len*math.sin(angle+0.4)) draw.line([(x2,y2), a1], fill=color, width=width) draw.line([(x2,y2), a2], fill=color, width=width) def get_font(size): try: return ImageFont.truetype('/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf', size) except: try: return ImageFont.truetype('/usr/share/fonts/truetype/liberation/LiberationSans-Bold.ttf', size) except: return ImageFont.load_default() def label_with_bg(draw, text, x, y, font, color): bbox = draw.textbbox((x, y), text, font=font) pad = 3 draw.rectangle([bbox[0]-pad, bbox[1]-pad, bbox[2]+pad, bbox[3]+pad], fill=(0,0,0,180)) draw.text((x, y), text, fill=color, font=font) for f in findings: img = Image.open(f['file']).convert('RGB') W, H = img.size draw = ImageDraw.Draw(img, 'RGBA') font_sm = get_font(max(12, int(H*0.025))) lw = max(2, int(H*0.004)) for ann in f['annotations']: c = ann['color'] lbl = ann['label'] if ann['type'] == 'rect': x = int(ann['x']*W); y = int(ann['y']*H) w = int(ann['w']*W); h = int(ann['h']*H) # semi-transparent fill overlay = Image.new('RGBA', img.size, (0,0,0,0)) od = ImageDraw.Draw(overlay) od.rectangle([x,y,x+w,y+h], outline=c+(255,), width=lw, fill=c+(40,)) img = Image.alpha_composite(img.convert('RGBA'), overlay).convert('RGB') draw = ImageDraw.Draw(img, 'RGBA') label_with_bg(draw, lbl, x+4, y+4, font_sm, (255,255,255)) elif ann['type'] == 'circle': cx = int(ann['x']*W); cy = int(ann['y']*H); r = int(ann['r']*min(W,H)) overlay = Image.new('RGBA', img.size, (0,0,0,0)) od = ImageDraw.Draw(overlay) od.ellipse([cx-r,cy-r,cx+r,cy+r], outline=c+(255,), width=lw, fill=c+(35,)) img = Image.alpha_composite(img.convert('RGBA'), overlay).convert('RGB') draw = ImageDraw.Draw(img, 'RGBA') label_with_bg(draw, lbl, cx-r, cy-r-int(font_sm.size*1.5), font_sm, (255,255,255)) elif ann['type'] == 'arrow': x1=int(ann['x1']*W); y1=int(ann['y1']*H) x2=int(ann['x2']*W); y2=int(ann['y2']*H) draw_arrow(draw, x1, y1, x2, y2, c+(255,), width=lw+1) label_with_bg(draw, lbl, x1, y1-int(font_sm.size*1.5), font_sm, (255,255,255)) img.save(f['out'], quality=92) print(f"Annotated: {f['out']}") print("All annotations done.") PYEOF

cd /tmp/workspace/tb-xray-pdf && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm, mm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Image as RLImage, Table, TableStyle, PageBreak, HRFlowable) from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY from reportlab.pdfgen import canvas from reportlab.platypus import BaseDocTemplate, Frame, PageTemplate from PIL import Image as PILImage import os OUTPUT = 'TB_Xray_Teaching_Guide.pdf' W, H = A4 # 595 x 842 pts # ── colour palette ──────────────────────────────────────────────────────────── DARK_BG = colors.HexColor('#0A1628') BLUE_MAIN = colors.HexColor('#1565C0') BLUE_LT = colors.HexColor('#1E88E5') ACCENT = colors.HexColor('#FF6B35') YELLOW = colors.HexColor('#FFD600') GREEN = colors.HexColor('#00C853') WHITE = colors.white LIGHT_BG = colors.HexColor('#E3F2FD') GREY_BG = colors.HexColor('#F5F5F5') RED_FIND = colors.HexColor('#E53935') # ── styles ──────────────────────────────────────────────────────────────────── styles = getSampleStyleSheet() def S(name, **kw): return ParagraphStyle(name, **kw) title_style = S('TitleMain', fontName='Helvetica-Bold', fontSize=28, textColor=WHITE, alignment=TA_CENTER, spaceAfter=6, leading=34) subtitle_style = S('Subtitle', fontName='Helvetica', fontSize=14, textColor=colors.HexColor('#90CAF9'), alignment=TA_CENTER, spaceAfter=4) section_num = S('SNum', fontName='Helvetica-Bold', fontSize=36, textColor=YELLOW, alignment=TA_CENTER, leading=42) finding_head = S('FindHead', fontName='Helvetica-Bold', fontSize=18, textColor=WHITE, alignment=TA_CENTER, spaceAfter=4, leading=22) finding_sub = S('FindSub', fontName='Helvetica', fontSize=11, textColor=colors.HexColor('#90CAF9'), alignment=TA_CENTER, spaceAfter=2) body_style = S('Body', fontName='Helvetica', fontSize=10, textColor=colors.HexColor('#212121'), spaceAfter=3, leading=14) bullet_style = S('Bullet', fontName='Helvetica', fontSize=10, textColor=colors.HexColor('#212121'), leftIndent=12, spaceAfter=2, leading=13) tip_style = S('Tip', fontName='Helvetica-Bold', fontSize=10, textColor=colors.HexColor('#BF360C'), spaceAfter=3, leading=13) label_style = S('Label', fontName='Helvetica-Bold', fontSize=9, textColor=BLUE_MAIN, alignment=TA_CENTER) caption_style= S('Caption', fontName='Helvetica-Oblique', fontSize=8, textColor=colors.HexColor('#546E7A'), alignment=TA_CENTER, spaceAfter=2) tbl_head = S('TblHead', fontName='Helvetica-Bold', fontSize=9, textColor=WHITE, alignment=TA_CENTER) tbl_body = S('TblBody', fontName='Helvetica', fontSize=8, textColor=colors.HexColor('#212121'), alignment=TA_CENTER) rule_style = S('Rule', fontName='Helvetica-Bold', fontSize=10, textColor=colors.HexColor('#1A237E'), spaceAfter=3, leading=14) # ── per-finding data ────────────────────────────────────────────────────────── findings = [ { 'num': '01', 'img': 'images/01_annotated.jpg', 'title': 'APICAL INFILTRATE', 'subtitle': 'Upper Lobe Opacity - The Classic TB Sign', 'tag': 'SECONDARY (REACTIVATION) TB', 'tag_color': RED_FIND, 'status': 'ACTIVE', 'body': 'TB bacilli preferentially colonise the upper lobes due to higher oxygen tension and poor lymphatic drainage. The apical and posterior segments of the upper lobe, and the superior segment of the lower lobe, are the classical sites.', 'bullets': [ 'Patchy, ill-defined opacity in the UPPER ZONE (above anterior end of 2nd rib)', 'Fluffy/cotton-wool appearance - poorly marginated borders', 'Unilateral initially; bilateral in advanced disease', 'Associated with volume loss and upward tracheal deviation', ], 'tip': 'GOLDEN RULE: In any chest X-ray - ALWAYS look at the upper lobes FIRST. TB lives at the apex!', 'color': RED_FIND, }, { 'num': '02', 'img': 'images/02_annotated.jpg', 'title': 'CAVITATION', 'subtitle': 'Thick-walled Radiolucent Hole - Tissue Necrosis', 'tag': 'ACTIVE TB - HIGHLY INFECTIOUS', 'tag_color': RED_FIND, 'status': 'ACTIVE', 'body': 'Cavitation occurs when caseous necrotic material liquefies and drains into the bronchus, leaving an air-filled space. Cavitating TB patients are sputum-smear positive and highly infectious.', 'bullets': [ 'Radiolucent (dark/black) area within a zone of consolidation', 'Thick, irregular wall (>3 mm) = ACTIVE cavity', 'Located in upper lobes (apical / posterior segments)', 'No air-fluid level unless secondary bacterial infection', 'Multiple cavities can coexist', ], 'tip': 'KEY DISTINCTION: Thick wall = Active TB (infectious!). Thin wall = Old/healed cavity or pneumatocele.', 'color': RED_FIND, }, { 'num': '03', 'img': 'images/03_cavity_airfluid.jpg', 'title': 'CAVITY WITH AIR-FLUID LEVEL', 'subtitle': 'Horizontal Line Inside a Cavity = Fluid + Pus', 'tag': 'ACTIVE TB + SECONDARY INFECTION', 'tag_color': colors.HexColor('#E65100'), 'status': 'ACTIVE', 'body': 'An air-fluid level inside a TB cavity indicates either active liquefaction of caseous necrosis OR superimposed bacterial infection (Aspergillus, Klebsiella, anaerobes). This changes management significantly.', 'bullets': [ 'HORIZONTAL line inside the cavity (same at all tilt angles)', 'Upper part = air (dark); Lower part = fluid (white)', 'Located in the upper lobe / apex', 'Bronchogenic spread shown as satellite nodules in lower zones', ], 'tip': 'CLINICAL PEARL: Air-fluid level in a TB cavity - think secondary Aspergilloma or bacterial superinfection. Get sputum cultures!', 'color': colors.HexColor('#E65100'), }, { 'num': '04', 'img': 'images/04_tree_in_bud.jpg', 'title': 'TREE-IN-BUD PATTERN', 'subtitle': 'Bronchogenic Spread - Like a Budding Tree', 'tag': 'ACTIVE ENDOBRONCHIAL SPREAD', 'tag_color': RED_FIND, 'status': 'ACTIVE - CONTAGIOUS', 'body': 'Tree-in-bud represents caseating material filling and expanding the centrilobular bronchioles. It is the hallmark of ACTIVE endobronchial spread of TB. Best seen on CT but can be suspected on CXR as ill-defined small nodules in clusters.', 'bullets': [ 'On CXR: small nodular-linear opacities radiating outward from hilum', 'Often accompanies a cavity in the ipsilateral upper lobe', 'Satellite nodules in mid and lower zones = spread', 'On CT (HRCT): classic "tree-in-bud" - centrilobular branching opacities', ], 'tip': 'Tree-in-bud = ACTIVE disease. This patient IS contagious. Isolate and start DOTS therapy immediately!', 'color': RED_FIND, }, { 'num': '05', 'img': 'images/05_bilateral_infiltrates.jpg', 'title': 'BILATERAL UPPER LOBE INFILTRATES', 'subtitle': 'Advanced / Extensive TB', 'tag': 'ADVANCED SECONDARY TB', 'tag_color': colors.HexColor('#880E4F'), 'status': 'ACTIVE - ADVANCED', 'body': 'Bilateral upper lobe involvement indicates advanced or poorly treated disease. Both lungs show evidence of TB - infiltrates, cavities, and fibronodular changes simultaneously. High bacillary load and infectivity.', 'bullets': [ 'RIGHT upper lobe: large heterogeneous infiltrate with cavity (radiolucent hole)', 'LEFT apex: patchy opacity (smaller infiltrate)', 'LEFT mid-zone: fibronodular shadows (older/healing lesions)', 'Tracheal deviation toward the more diseased side (fibrosis)', ], 'tip': 'Bilateral upper lobe disease = extensive TB. Screen contacts aggressively. Check for drug resistance (MDR-TB).', 'color': colors.HexColor('#880E4F'), }, { 'num': '06', 'img': 'images/06_calcified_nodes.jpg', 'title': 'CALCIFIED HILAR NODES (RANKE COMPLEX)', 'subtitle': 'Healed Primary TB - Permanent Calcification', 'tag': 'OLD / HEALED PRIMARY TB', 'tag_color': colors.HexColor('#2E7D32'), 'status': 'OLD / HEALED', 'body': 'Calcification of the Ghon focus (lung) + draining lymph node = Ghon complex. When the node alone calcifies prominently at the hilum, it is called the Ranke complex. This is a hallmark of HEALED primary TB and persists lifelong.', 'bullets': [ 'Dense WHITE/calcium-density nodules at the hilum or mediastinum', 'Bilateral or unilateral hilar calcification', 'May coexist with active reactivation disease in upper lobes', 'Blunted costophrenic angles indicate associated pleural effusion here', ], 'tip': 'Calcified hilar node = OLD TB. But always check upper lobes for ACTIVE reactivation co-existing in the same patient!', 'color': colors.HexColor('#2E7D32'), }, { 'num': '07', 'img': 'images/07_hilar_lymphadenopathy.jpg', 'title': 'HILAR LYMPHADENOPATHY', 'subtitle': 'Primary TB Pattern - Seen Mainly in Children', 'tag': 'PRIMARY TB (CHILDREN / YOUNG ADULTS)', 'tag_color': BLUE_MAIN, 'status': 'ACTIVE PRIMARY', 'body': 'In primary TB (first exposure), the immune response is focused on the draining lymph nodes. Massive hilar and mediastinal lymphadenopathy dominates the CXR. This is the OPPOSITE of reactivation TB where upper lobe parenchymal changes dominate.', 'bullets': [ 'Widened, lobulated hilar shadows bilaterally or unilaterally', 'Dense hilar opacity - the hilum "bulges" outward', 'Ghon focus: small peripheral infiltrate (often not visible on CXR)', 'Can compress bronchi causing lobar collapse (especially right middle lobe)', 'Apical opacity may coexist in adolescents', ], 'tip': "RULE: Primary TB (children) = LYMPHADENOPATHY dominates. Reactivation TB (adults) = UPPER LOBE CHANGES dominate.", 'color': BLUE_MAIN, }, { 'num': '08', 'img': 'images/08_pleural_effusion.jpg', 'title': 'PLEURAL EFFUSION', 'subtitle': 'Exudative Effusion - Hypersensitivity Reaction', 'tag': 'PRIMARY OR SECONDARY TB', 'tag_color': colors.HexColor('#00695C'), 'status': 'ACTIVE', 'body': 'TB pleural effusion is an exudate caused by delayed hypersensitivity to TB antigens leaking from a sub-pleural focus. It is almost always unilateral. The fluid is lymphocyte-predominant with high ADA (adenosine deaminase).', 'bullets': [ 'BLUNTED costophrenic angle (earliest sign - >200 mL fluid)', 'MENISCUS sign: fluid curves upward at the lateral chest wall', 'Homogeneous white opacity in the lower zone', 'Trachea/mediastinum shift AWAY from effusion (if large)', 'Almost always UNILATERAL in TB', ], 'tip': 'TB pleural effusion = UNILATERAL + EXUDATE + ADA >40 U/L. Bilateral effusion = think other causes (malignancy, cardiac).', 'color': colors.HexColor('#00695C'), }, { 'num': '09', 'img': 'images/09_miliary_tb.jpg', 'title': 'MILIARY TUBERCULOSIS', 'subtitle': 'Hematogenous Spread - Millet Seed Pattern', 'tag': '⚠ LIFE-THREATENING EMERGENCY', 'tag_color': RED_FIND, 'status': 'ACTIVE - EMERGENCY', 'body': 'Miliary TB results from massive hematogenous dissemination of TB bacilli throughout both lungs simultaneously. The name comes from "milium" (millet seed). It carries a high mortality if not treated promptly.', 'bullets': [ 'Countless TINY nodules: 1-3 mm in size', 'UNIFORM size, density and distribution throughout BOTH lungs', 'ALL zones affected equally - upper, mid, AND lower', 'No zone-sparing (unlike secondary TB which spares lower zones)', 'CXR: looks like "sand thrown at both lungs"', ], 'tip': '⚠ EMERGENCY: Miliary TB = multi-organ involvement. Check CSF (meningitis), LFTs (hepatic TB). Start 4-drug DOTS immediately!', 'color': RED_FIND, }, { 'num': '10', 'img': 'images/10_pneumatocele.jpg', 'title': 'PNEUMATOCELE / POST-TB SEQUELAE', 'subtitle': 'Thin-walled Cysts After Healed TB', 'tag': 'OLD TB - POST-TREATMENT SEQUELAE', 'tag_color': colors.HexColor('#4A148C'), 'status': 'OLD / HEALED', 'body': 'After successful TB treatment, healed cavities may persist as thin-walled air cysts called pneumatoceles. Residual fibrosis, scarring, and volume loss are also seen. These are NOT infectious but may be complicated by Aspergilloma.', 'bullets': [ 'Large, THIN-walled (<1 mm) air-filled cysts in upper lobe', 'Multiple cysts may coalesce', 'Residual reticulonodular opacities = healed fibronodular disease', 'Upper lobe volume loss: tracheal/fissure displacement upward', 'Risk of Aspergilloma (fungal ball) in old cavities', ], 'tip': 'Thin wall = OLD/healed (safe). Thick wall = ACTIVE. An air crescent sign inside an old cavity = Aspergilloma (complication!).', 'color': colors.HexColor('#4A148C'), }, ] # ── helper: draw coloured background on a page ─────────────────────────────── class BackgroundCanvas(canvas.Canvas): def __init__(self, *a, **kw): super().__init__(*a, **kw) self._page_type = 'content' def cover_page(c, doc): c.saveState() c.setFillColor(DARK_BG); c.rect(0,0,W,H,fill=1,stroke=0) # gradient stripes for i in range(8): alpha = 0.04 + i*0.01 c.setFillColorRGB(0.08,0.4,0.76, alpha) c.rect(0, H*(0.1*i), W, H*0.12, fill=1, stroke=0) # accent bar top c.setFillColor(BLUE_LT); c.rect(0, H-6, W, 6, fill=1, stroke=0) c.setFillColor(ACCENT); c.rect(0, H-12, W, 6, fill=1, stroke=0) # red cross symbol cx, cy, arm = W/2, H*0.60, 28 c.setFillColor(RED_FIND) c.rect(cx-arm*0.3, cy-arm, arm*0.6, arm*2, fill=1, stroke=0) c.rect(cx-arm, cy-arm*0.3, arm*2, arm*0.6, fill=1, stroke=0) # footer bar c.setFillColor(BLUE_MAIN); c.rect(0,0,W,28,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(WHITE) c.drawCentredString(W/2,10,'Pulmonary TB X-Ray Teaching Guide | For Educational Use Only') c.restoreState() def content_page(c, doc): c.saveState() c.setFillColor(colors.HexColor('#FAFAFA')); c.rect(0,0,W,H,fill=1,stroke=0) # top bar c.setFillColor(DARK_BG); c.rect(0,H-36,W,36,fill=1,stroke=0) c.setFont('Helvetica-Bold',9); c.setFillColor(WHITE) c.drawString(12,H-24,'PULMONARY TUBERCULOSIS | CHEST X-RAY TEACHING SERIES') c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawRightString(W-12,H-24,'For Educational Use Only') # bottom bar c.setFillColor(DARK_BG); c.rect(0,0,W,22,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawCentredString(W/2, 7, f'Page {doc.page}') c.restoreState() def summary_page(c, doc): c.saveState() c.setFillColor(DARK_BG); c.rect(0,0,W,H,fill=1,stroke=0) c.setFillColor(BLUE_MAIN); c.rect(0,H-36,W,36,fill=1,stroke=0) c.setFont('Helvetica-Bold',10); c.setFillColor(WHITE) c.drawCentredString(W/2,H-22,'SUMMARY TABLE | ALL TB X-RAY FINDINGS') c.setFillColor(DARK_BG); c.rect(0,0,W,22,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawCentredString(W/2, 7, f'Page {doc.page}') c.restoreState() # ── document setup ──────────────────────────────────────────────────────────── doc = SimpleDocTemplate( OUTPUT, pagesize=A4, topMargin=48, bottomMargin=32, leftMargin=28, rightMargin=28, title='Pulmonary TB Chest X-Ray Teaching Guide', author='Orris Medical Education', subject='Radiology Teaching - Tuberculosis' ) story = [] # ════════════════════ COVER PAGE ══════════════════════════════════════════════ from reportlab.platypus import FrameBreak, NextPageTemplate, PageBreak # We'll use OnePage approach with canvas callbacks # Build a single-pass document from reportlab.platypus import SimpleDocTemplate # ── COVER ────────────────────────────────────────────────────────────────────── story.append(Spacer(1, 2.2*cm)) story.append(Paragraph('<font color="#FFD600" size="13">📋 RADIOLOGY TEACHING SERIES</font>', S('', fontName='Helvetica-Bold', fontSize=13, textColor=YELLOW, alignment=TA_CENTER, spaceAfter=4))) story.append(Spacer(1,0.3*cm)) story.append(Paragraph('PULMONARY TUBERCULOSIS', S('', fontName='Helvetica-Bold', fontSize=30, textColor=WHITE, alignment=TA_CENTER, spaceAfter=6, leading=36))) story.append(Paragraph('Complete Chest X-Ray Findings', S('', fontName='Helvetica-Bold', fontSize=18, textColor=colors.HexColor('#90CAF9'), alignment=TA_CENTER, spaceAfter=4))) story.append(Spacer(1,0.4*cm)) story.append(HRFlowable(width='80%', thickness=2, color=ACCENT, spaceAfter=10, spaceBefore=4)) story.append(Paragraph('One Finding · One X-Ray · Complete Learning', S('', fontName='Helvetica-Oblique', fontSize=12, textColor=colors.HexColor('#B0BEC5'), alignment=TA_CENTER, spaceAfter=4))) story.append(Spacer(1,3.5*cm)) # badge row badge_data = [ [Paragraph('<font color="white"><b>10</b></font>', S('', fontName='Helvetica-Bold', fontSize=28, textColor=WHITE, alignment=TA_CENTER)), Paragraph('<font color="white"><b>10</b></font>', S('', fontName='Helvetica-Bold', fontSize=28, textColor=WHITE, alignment=TA_CENTER)), Paragraph('<font color="white"><b>100%</b></font>', S('', fontName='Helvetica-Bold', fontSize=28, textColor=WHITE, alignment=TA_CENTER))], [Paragraph('X-Ray Cases', S('', fontName='Helvetica', fontSize=9, textColor=colors.HexColor('#90CAF9'), alignment=TA_CENTER)), Paragraph('TB Findings', S('', fontName='Helvetica', fontSize=9, textColor=colors.HexColor('#90CAF9'), alignment=TA_CENTER)), Paragraph('Annotated Images', S('', fontName='Helvetica', fontSize=9, textColor=colors.HexColor('#90CAF9'), alignment=TA_CENTER))], ] bt = Table(badge_data, colWidths=[5*cm]*3) bt.setStyle(TableStyle([ ('BACKGROUND', (0,0),(0,1), BLUE_MAIN), ('BACKGROUND', (1,0),(1,1), RED_FIND), ('BACKGROUND', (2,0),(2,1), colors.HexColor('#2E7D32')), ('ROUNDEDCORNERS', [8]), ('VALIGN', (0,0),(-1,-1),'MIDDLE'), ('TOPPADDING',(0,0),(-1,-1),8), ('BOTTOMPADDING',(0,0),(-1,-1),8), ('LEFTPADDING',(0,0),(-1,-1),4), ('RIGHTPADDING',(0,0),(-1,-1),4), ])) story.append(bt) story.append(Spacer(1,2*cm)) story.append(Paragraph('Mycobacterium tuberculosis | Pulmonary Radiology', S('', fontName='Helvetica', fontSize=9, textColor=colors.HexColor('#607D8B'), alignment=TA_CENTER))) story.append(PageBreak()) # ════════════════════ FINDING PAGES ═══════════════════════════════════════════ for i, f in enumerate(findings): # ── section header strip ────────────────────────────────────────────────── hdr_data = [[ Paragraph(f['num'], S('', fontName='Helvetica-Bold', fontSize=32, textColor=YELLOW, alignment=TA_CENTER)), Paragraph(f'<b>{f["title"]}</b><br/><font size="10" color="#90CAF9">{f["subtitle"]}</font>', S('', fontName='Helvetica-Bold', fontSize=16, textColor=WHITE, leading=20, spaceAfter=2)), Paragraph(f'<b>{f["status"]}</b>', S('', fontName='Helvetica-Bold', fontSize=9, textColor=WHITE, alignment=TA_CENTER)), ]] hdr_t = Table(hdr_data, colWidths=[2*cm, 11.5*cm, 3*cm]) hdr_t.setStyle(TableStyle([ ('BACKGROUND', (0,0),(-1,-1), DARK_BG), ('VALIGN', (0,0),(-1,-1), 'MIDDLE'), ('TOPPADDING', (0,0),(-1,-1), 8), ('BOTTOMPADDING', (0,0),(-1,-1), 8), ('LEFTPADDING', (0,0),(0,0), 6), ('BACKGROUND', (2,0),(2,0), f['color']), ('ROUNDEDCORNERS', [4]), ])) story.append(hdr_t) story.append(Spacer(1, 4)) # ── tag pill ────────────────────────────────────────────────────────────── tag_d = [[Paragraph(f'<b>{f["tag"]}</b>', S('', fontName='Helvetica-Bold', fontSize=9, textColor=WHITE, alignment=TA_CENTER))]] tag_t = Table(tag_d, colWidths=[16.5*cm]) tag_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1), f['tag_color']), ('TOPPADDING',(0,0),(-1,-1),4), ('BOTTOMPADDING',(0,0),(-1,-1),4), ('ROUNDEDCORNERS',[4]), ])) story.append(tag_t) story.append(Spacer(1, 6)) # ── annotated image ─────────────────────────────────────────────────────── pil = PILImage.open(f['img']) iw, ih = pil.size max_w = 16.5*cm max_h = 10.5*cm scale = min(max_w/iw, max_h/ih) disp_w, disp_h = iw*scale, ih*scale ri = RLImage(f['img'], width=disp_w, height=disp_h) ri.hAlign = 'CENTER' # image border table img_d = [[ri]] img_t = Table(img_d, colWidths=[16.5*cm]) img_t.setStyle(TableStyle([ ('ALIGN',(0,0),(-1,-1),'CENTER'), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('BOX',(0,0),(-1,-1), 2, BLUE_LT), ('BACKGROUND',(0,0),(-1,-1), colors.black), ('TOPPADDING',(0,0),(-1,-1),4), ('BOTTOMPADDING',(0,0),(-1,-1),4), ])) story.append(img_t) story.append(Spacer(1,4)) # Annotation key ann_key = Paragraph('<i>Red = Main Finding &nbsp;|&nbsp; Orange = Secondary Finding &nbsp;|&nbsp; Blue = Associated Feature &nbsp;|&nbsp; Green = Chronic/Old Change &nbsp;|&nbsp; Yellow = Key Point / Arrow</i>', S('', fontName='Helvetica-Oblique', fontSize=7.5, textColor=colors.HexColor('#546E7A'), alignment=TA_CENTER, spaceAfter=2)) story.append(ann_key) story.append(Spacer(1,4)) # ── two-column layout: body + bullets ───────────────────────────────────── body_p = Paragraph(f['body'], body_style) bullets_text = ''.join([f'<bullet>&bull;</bullet>{b}<br/>' for b in f['bullets']]) bullets_p = Paragraph(bullets_text, S('', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#212121'), leading=14, spaceAfter=2)) left_d = [[Paragraph('<b>DESCRIPTION</b>', S('', fontName='Helvetica-Bold', fontSize=8, textColor=BLUE_MAIN, spaceAfter=3))], [body_p]] right_d = [[Paragraph('<b>WHAT TO LOOK FOR</b>', S('', fontName='Helvetica-Bold', fontSize=8, textColor=RED_FIND, spaceAfter=3))], [bullets_p]] lt = Table(left_d, colWidths=[8*cm]) lt.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1), LIGHT_BG), ('TOPPADDING',(0,0),(-1,-1),6), ('BOTTOMPADDING',(0,0),(-1,-1),6), ('LEFTPADDING',(0,0),(-1,-1),8), ('RIGHTPADDING',(0,0),(-1,-1),8), ('ROUNDEDCORNERS',[4]), ])) rt = Table(right_d, colWidths=[8*cm]) rt.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1), colors.HexColor('#FFF3E0')), ('TOPPADDING',(0,0),(-1,-1),6), ('BOTTOMPADDING',(0,0),(-1,-1),6), ('LEFTPADDING',(0,0),(-1,-1),8), ('RIGHTPADDING',(0,0),(-1,-1),8), ('ROUNDEDCORNERS',[4]), ])) two_col = Table([[lt, rt]], colWidths=[8.2*cm, 8.3*cm], spaceBefore=0) two_col.setStyle(TableStyle([ ('VALIGN',(0,0),(-1,-1),'TOP'), ('LEFTPADDING',(0,0),(-1,-1),0), ('RIGHTPADDING',(0,0),(-1,-1),0), ('TOPPADDING',(0,0),(-1,-1),0), ('BOTTOMPADDING',(0,0),(-1,-1),0), ('INNERGRID',(0,0),(-1,-1), 0, colors.white), ('BACKGROUND',(0,0),(-1,-1), colors.white), ('LEFTPADDING',(1,0),(1,0), 4), ])) story.append(two_col) story.append(Spacer(1,5)) # ── tip box ─────────────────────────────────────────────────────────────── tip_d = [[Paragraph(f'<b>CLINICAL TIP:</b> {f["tip"]}', S('', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#BF360C'), leading=13))]] tip_t = Table(tip_d, colWidths=[16.5*cm]) tip_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1), colors.HexColor('#FFF8E1')), ('BOX',(0,0),(-1,-1), 1.5, ACCENT), ('LEFTPADDING',(0,0),(-1,-1),10), ('RIGHTPADDING',(0,0),(-1,-1),10), ('TOPPADDING',(0,0),(-1,-1),6), ('BOTTOMPADDING',(0,0),(-1,-1),6), ('ROUNDEDCORNERS',[4]), ])) story.append(tip_t) story.append(PageBreak()) # ════════════════════ SUMMARY TABLE ═══════════════════════════════════════════ story.append(Spacer(1,0.4*cm)) story.append(Paragraph('COMPLETE SUMMARY TABLE', S('', fontName='Helvetica-Bold', fontSize=18, textColor=WHITE, alignment=TA_CENTER, spaceAfter=4))) story.append(Paragraph('All 10 TB X-Ray Findings at a Glance', S('', fontName='Helvetica', fontSize=11, textColor=colors.HexColor('#90CAF9'), alignment=TA_CENTER, spaceAfter=8))) story.append(Spacer(1,0.3*cm)) tbl_data = [ [Paragraph('#', tbl_head), Paragraph('Finding', tbl_head), Paragraph('Zone', tbl_head), Paragraph('Status', tbl_head), Paragraph('Key Point', tbl_head)], ['01', 'Apical Infiltrate', 'Upper lobes', 'Active', 'First thing to look at on any CXR'], ['02', 'Thick-walled Cavity', 'Upper lobes', 'Active', 'Thick wall = Active & infectious'], ['03', 'Cavity + Air-fluid Level', 'Upper lobes', 'Active', 'Think secondary infection/Aspergillus'], ['04', 'Tree-in-Bud (Bronchogenic)', 'Any zone', 'Active', 'Patient is contagious - ISOLATE'], ['05', 'Bilateral Upper Infiltrates', 'Both upper lobes', 'Advanced', 'Screen for MDR-TB'], ['06', 'Calcified Nodes (Ranke)', 'Hilum', 'Old/Healed', 'Permanent sign of healed primary TB'], ['07', 'Hilar Lymphadenopathy', 'Hilum/Mediastinum', 'Primary TB', 'Children - nodes dominate'], ['08', 'Pleural Effusion', 'Lower zone', 'Active', 'Almost always unilateral in TB'], ['09', 'Miliary Pattern', 'Both lungs', 'EMERGENCY', '1-3 mm nodules = hematogenous spread'], ['10', 'Pneumatocele/Sequelae', 'Upper lobes', 'Old/Healed', 'Thin wall = old; risk of Aspergilloma'], ] col_w = [1.0*cm, 3.8*cm, 3.0*cm, 2.5*cm, 6.2*cm] t = Table(tbl_data, colWidths=col_w, repeatRows=1) ts = TableStyle([ ('BACKGROUND',(0,0),(-1,0), DARK_BG), ('TEXTCOLOR',(0,0),(-1,0), WHITE), ('FONTNAME',(0,0),(-1,0), 'Helvetica-Bold'), ('FONTSIZE',(0,0),(-1,0), 9), ('ALIGN',(0,0),(-1,-1),'CENTER'), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('FONTNAME',(0,1),(-1,-1), 'Helvetica'), ('FONTSIZE',(0,1),(-1,-1), 8.5), ('ROWBACKGROUNDS',(0,1),(-1,-1), [colors.HexColor('#E3F2FD'), colors.white]), ('GRID',(0,0),(-1,-1), 0.5, colors.HexColor('#B0BEC5')), ('TOPPADDING',(0,0),(-1,-1), 5), ('BOTTOMPADDING',(0,0),(-1,-1), 5), ('LEFTPADDING',(0,0),(-1,-1), 5), ('RIGHTPADDING',(0,0),(-1,-1), 5), # colour the status column ('TEXTCOLOR',(3,1),(3,5), RED_FIND), ('TEXTCOLOR',(3,6),(3,6), BLUE_MAIN), ('TEXTCOLOR',(3,7),(3,7), RED_FIND), ('TEXTCOLOR',(3,8),(3,8), RED_FIND), ('BACKGROUND',(3,9),(3,9), RED_FIND), ('TEXTCOLOR',(3,9),(3,9), WHITE), ('FONTNAME',(3,9),(3,9), 'Helvetica-Bold'), ('TEXTCOLOR',(3,10),(3,10), colors.HexColor('#2E7D32')), ('FONTNAME',(0,1),(-1,-1), 'Helvetica'), ('ALIGN',(4,1),(4,-1),'LEFT'), ]) t.setStyle(ts) story.append(t) story.append(Spacer(1,0.6*cm)) # Golden rules box rules = [ '1. Always look at the UPPER LOBES first - TB lives at the apex', '2. Active TB = infiltrates + thick-walled cavities + tree-in-bud', '3. Old TB = calcifications + thin-walled cysts + fibrosis + volume loss', '4. Primary TB (children) = hilar adenopathy dominates', '5. Secondary TB (adults/reactivation) = upper lobe changes dominate', '6. Miliary TB = bilateral, uniform, tiny (1-3 mm) nodules = EMERGENCY', '7. TB pleural effusion = almost always UNILATERAL, exudate, high ADA', ] rules_text = '<br/>'.join([f'<b>{r}</b>' for r in rules]) rules_d = [[Paragraph('<b>THE GOLDEN RULES OF TB RADIOLOGY</b>', S('', fontName='Helvetica-Bold', fontSize=11, textColor=YELLOW, spaceAfter=6))], [Paragraph(rules_text, S('', fontName='Helvetica', fontSize=9.5, textColor=WHITE, leading=15))]] rules_t = Table(rules_d, colWidths=[16.5*cm]) rules_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1), DARK_BG), ('TOPPADDING',(0,0),(-1,-1),10), ('BOTTOMPADDING',(0,0),(-1,-1),10), ('LEFTPADDING',(0,0),(-1,-1),14), ('RIGHTPADDING',(0,0),(-1,-1),14), ('ROUNDEDCORNERS',[6]), ])) story.append(rules_t) # ── build ────────────────────────────────────────────────────────────────────── page_callbacks = {1: cover_page} current_cb = [cover_page] def on_page(c, doc): if doc.page == 1: cover_page(c, doc) elif doc.page == len(findings)+3: summary_page(c, doc) else: content_page(c, doc) doc.build(story, onFirstPage=on_page, onLaterPages=on_page) print(f'PDF created: {OUTPUT} ({os.path.getsize(OUTPUT)//1024} KB)') PYEOF

cd /tmp/workspace/tb-xray-pdf && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Image as RLImage, Table, TableStyle, PageBreak, HRFlowable) from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from reportlab.pdfgen import canvas from PIL import Image as PILImage import os OUTPUT = 'TB_Xray_Teaching_Guide.pdf' W, H = A4 DARK_BG = colors.HexColor('#0A1628') BLUE_MAIN = colors.HexColor('#1565C0') BLUE_LT = colors.HexColor('#1E88E5') ACCENT = colors.HexColor('#FF6B35') YELLOW = colors.HexColor('#FFD600') WHITE = colors.white LIGHT_BG = colors.HexColor('#E3F2FD') RED_FIND = colors.HexColor('#E53935') def S(name, **kw): return ParagraphStyle(name, **kw) body_style = S('Body', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#212121'), spaceAfter=3, leading=13) bullet_st = S('Bul', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#212121'), leading=13, spaceAfter=2, leftIndent=8, firstLineIndent=-8) tbl_head = S('TH', fontName='Helvetica-Bold', fontSize=9, textColor=WHITE, alignment=TA_CENTER) tbl_body_s = S('TB', fontName='Helvetica', fontSize=8.5, textColor=colors.HexColor('#212121'), alignment=TA_CENTER) findings = [ { 'num': '01', 'img': 'images/01_annotated.jpg', 'title': 'APICAL INFILTRATE', 'subtitle': 'Upper Lobe Opacity - The Classic TB Sign', 'tag': 'SECONDARY (REACTIVATION) TB', 'tag_color': RED_FIND, 'status': 'ACTIVE', 'body': 'TB bacilli preferentially colonise the upper lobes due to higher oxygen tension and poor lymphatic drainage. The apical and posterior segments of the upper lobe, and the superior segment of the lower lobe, are the classical sites.', 'bullets': [ 'Patchy, ill-defined opacity in the UPPER ZONE (above anterior 2nd rib)', 'Fluffy/cotton-wool appearance - poorly marginated borders', 'Unilateral initially; bilateral in advanced disease', 'Associated with volume loss and upward tracheal deviation', ], 'tip': 'GOLDEN RULE: In any chest X-ray - ALWAYS look at the upper lobes FIRST. TB lives at the apex!', 'color': RED_FIND, }, { 'num': '02', 'img': 'images/02_annotated.jpg', 'title': 'CAVITATION', 'subtitle': 'Thick-walled Radiolucent Hole - Tissue Necrosis', 'tag': 'ACTIVE TB - HIGHLY INFECTIOUS', 'tag_color': RED_FIND, 'status': 'ACTIVE', 'body': 'Cavitation occurs when caseous necrotic material liquefies and drains into the bronchus, leaving an air-filled space. Cavitating TB patients are sputum-smear positive and highly infectious.', 'bullets': [ 'Radiolucent (dark/black) area within a zone of consolidation', 'Thick, irregular wall (>3 mm) = ACTIVE cavity', 'Located in upper lobes (apical / posterior segments)', 'No air-fluid level unless secondary bacterial infection', 'Multiple cavities can coexist', ], 'tip': 'KEY DISTINCTION: Thick wall = Active TB (infectious!). Thin wall = Old/healed cavity or pneumatocele.', 'color': RED_FIND, }, { 'num': '03', 'img': 'images/03_cavity_airfluid.jpg', 'title': 'CAVITY WITH AIR-FLUID LEVEL', 'subtitle': 'Horizontal Line Inside a Cavity = Fluid + Pus', 'tag': 'ACTIVE TB + SECONDARY INFECTION', 'tag_color': colors.HexColor('#E65100'), 'status': 'ACTIVE', 'body': 'An air-fluid level inside a TB cavity indicates either active liquefaction of caseous necrosis OR superimposed bacterial infection. This changes management significantly.', 'bullets': [ 'HORIZONTAL line inside the cavity (same at all tilt angles)', 'Upper part = air (dark); Lower part = fluid (white)', 'Located in the upper lobe / apex', 'Bronchogenic spread shown as satellite nodules in lower zones', ], 'tip': 'CLINICAL PEARL: Air-fluid level in a TB cavity - think secondary Aspergilloma or bacterial superinfection. Get sputum cultures!', 'color': colors.HexColor('#E65100'), }, { 'num': '04', 'img': 'images/04_tree_in_bud.jpg', 'title': 'TREE-IN-BUD PATTERN', 'subtitle': 'Bronchogenic Spread - Like a Budding Tree', 'tag': 'ACTIVE ENDOBRONCHIAL SPREAD', 'tag_color': RED_FIND, 'status': 'ACTIVE - CONTAGIOUS', 'body': 'Tree-in-bud represents caseating material filling the centrilobular bronchioles. It is the hallmark of ACTIVE endobronchial spread of TB. Best seen on HRCT but suspected on CXR as ill-defined nodular clusters.', 'bullets': [ 'On CXR: small nodular-linear opacities radiating outward from hilum', 'Often accompanies a cavity in the ipsilateral upper lobe', 'Satellite nodules in mid and lower zones = spread', 'On HRCT: classic centrilobular branching opacities (tree-in-bud)', ], 'tip': 'Tree-in-bud = ACTIVE disease. This patient IS contagious. Isolate and start DOTS therapy immediately!', 'color': RED_FIND, }, { 'num': '05', 'img': 'images/05_bilateral_infiltrates.jpg', 'title': 'BILATERAL UPPER LOBE INFILTRATES', 'subtitle': 'Advanced / Extensive TB', 'tag': 'ADVANCED SECONDARY TB', 'tag_color': colors.HexColor('#880E4F'), 'status': 'ACTIVE - ADVANCED', 'body': 'Bilateral upper lobe involvement indicates advanced or poorly treated disease. Both lungs show evidence of TB - infiltrates, cavities, and fibronodular changes simultaneously with high bacillary load.', 'bullets': [ 'RIGHT upper lobe: large heterogeneous infiltrate with cavity', 'LEFT apex: patchy opacity (smaller infiltrate)', 'LEFT mid-zone: fibronodular shadows (older/healing lesions)', 'Tracheal deviation toward the more fibrotic side', ], 'tip': 'Bilateral upper lobe disease = extensive TB. Screen contacts aggressively. Check for drug resistance (MDR-TB).', 'color': colors.HexColor('#880E4F'), }, { 'num': '06', 'img': 'images/06_calcified_nodes.jpg', 'title': 'CALCIFIED HILAR NODES (RANKE COMPLEX)', 'subtitle': 'Healed Primary TB - Permanent Calcification', 'tag': 'OLD / HEALED PRIMARY TB', 'tag_color': colors.HexColor('#2E7D32'), 'status': 'OLD / HEALED', 'body': 'Calcification of the Ghon focus (lung) + draining lymph node = Ghon complex. When the node calcifies prominently at the hilum, it is called the Ranke complex. This is a hallmark of HEALED primary TB and persists lifelong.', 'bullets': [ 'Dense WHITE/calcium-density nodules at the hilum or mediastinum', 'Bilateral or unilateral hilar calcification', 'May coexist with active reactivation disease in upper lobes', 'Blunted costophrenic angles = associated pleural effusion', ], 'tip': 'Calcified hilar node = OLD TB. But always check upper lobes for ACTIVE reactivation co-existing in the same patient!', 'color': colors.HexColor('#2E7D32'), }, { 'num': '07', 'img': 'images/07_hilar_lymphadenopathy.jpg', 'title': 'HILAR LYMPHADENOPATHY', 'subtitle': 'Primary TB Pattern - Seen Mainly in Children', 'tag': 'PRIMARY TB (CHILDREN / YOUNG ADULTS)', 'tag_color': BLUE_MAIN, 'status': 'ACTIVE PRIMARY', 'body': 'In primary TB, the immune response focuses on draining lymph nodes. Massive hilar and mediastinal lymphadenopathy dominates the CXR. This is the OPPOSITE of reactivation TB where upper lobe parenchymal changes dominate.', 'bullets': [ 'Widened, lobulated hilar shadows (bilateral or unilateral)', 'Dense hilar opacity - the hilum bulges outward', 'Can compress bronchi causing lobar collapse (right middle lobe)', 'Ghon focus: small peripheral infiltrate (often not visible on CXR)', 'Apical opacity may coexist in adolescents', ], 'tip': 'RULE: Primary TB (children) = LYMPHADENOPATHY dominates. Reactivation TB (adults) = UPPER LOBE CHANGES dominate.', 'color': BLUE_MAIN, }, { 'num': '08', 'img': 'images/08_pleural_effusion.jpg', 'title': 'PLEURAL EFFUSION', 'subtitle': 'Exudative Effusion - Hypersensitivity Reaction', 'tag': 'PRIMARY OR SECONDARY TB', 'tag_color': colors.HexColor('#00695C'), 'status': 'ACTIVE', 'body': 'TB pleural effusion is an exudate caused by delayed hypersensitivity to TB antigens leaking from a sub-pleural focus. It is almost always unilateral. Fluid is lymphocyte-predominant with high ADA.', 'bullets': [ 'BLUNTED costophrenic angle (earliest sign - >200 mL fluid)', 'MENISCUS sign: fluid curves upward at the lateral chest wall', 'Homogeneous white opacity in the lower zone', 'Trachea/mediastinum shift AWAY from effusion (if large)', 'Almost always UNILATERAL in TB', ], 'tip': 'TB pleural effusion = UNILATERAL + EXUDATE + ADA >40 U/L. Bilateral effusion = think other causes (malignancy, cardiac).', 'color': colors.HexColor('#00695C'), }, { 'num': '09', 'img': 'images/09_miliary_tb.jpg', 'title': 'MILIARY TUBERCULOSIS', 'subtitle': 'Hematogenous Spread - Millet Seed Pattern', 'tag': 'LIFE-THREATENING EMERGENCY', 'tag_color': RED_FIND, 'status': 'ACTIVE - EMERGENCY', 'body': 'Miliary TB results from massive hematogenous dissemination of TB bacilli throughout both lungs simultaneously. The name comes from "milium" (millet seed). It carries a high mortality if not treated promptly.', 'bullets': [ 'Countless TINY nodules: 1-3 mm in size', 'UNIFORM size, density and distribution throughout BOTH lungs', 'ALL zones affected equally - upper, mid, AND lower', 'No zone-sparing (unlike secondary TB which spares lower zones)', 'CXR looks like "sand thrown at both lungs"', ], 'tip': 'EMERGENCY: Miliary TB = multi-organ involvement. Check CSF (meningitis), LFTs (hepatic TB). Start 4-drug DOTS immediately!', 'color': RED_FIND, }, { 'num': '10', 'img': 'images/10_pneumatocele.jpg', 'title': 'PNEUMATOCELE / POST-TB SEQUELAE', 'subtitle': 'Thin-walled Cysts After Healed TB', 'tag': 'OLD TB - POST-TREATMENT SEQUELAE', 'tag_color': colors.HexColor('#4A148C'), 'status': 'OLD / HEALED', 'body': 'After successful TB treatment, healed cavities may persist as thin-walled air cysts called pneumatoceles. Residual fibrosis, scarring, and volume loss are also seen. Risk of Aspergilloma in old cavities.', 'bullets': [ 'Large, THIN-walled (<1 mm) air-filled cysts in upper lobe', 'Multiple cysts may coalesce', 'Residual reticulonodular opacities = healed fibronodular disease', 'Upper lobe volume loss: tracheal/fissure displacement upward', 'Risk of Aspergilloma (fungal ball) in old cavities', ], 'tip': 'Thin wall = OLD/healed (safe). Thick wall = ACTIVE. Air crescent sign inside old cavity = Aspergilloma (complication!).', 'color': colors.HexColor('#4A148C'), }, ] def on_page(c, doc): pg = doc.page c.saveState() if pg == 1: # cover c.setFillColor(DARK_BG); c.rect(0,0,W,H,fill=1,stroke=0) for i in range(8): c.setFillColorRGB(0.08,0.4,0.76, 0.04+i*0.01) c.rect(0, H*(0.1*i), W, H*0.12, fill=1, stroke=0) c.setFillColor(BLUE_LT); c.rect(0,H-6,W,6,fill=1,stroke=0) c.setFillColor(ACCENT); c.rect(0,H-12,W,6,fill=1,stroke=0) c.setFillColor(DARK_BG); c.rect(0,0,W,28,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(WHITE) c.drawCentredString(W/2,10,'Pulmonary TB X-Ray Teaching Guide | For Educational Use Only') elif pg == len(findings)+2: # summary page c.setFillColor(DARK_BG); c.rect(0,0,W,H,fill=1,stroke=0) c.setFillColor(BLUE_MAIN); c.rect(0,H-40,W,40,fill=1,stroke=0) c.setFont('Helvetica-Bold',10); c.setFillColor(WHITE) c.drawCentredString(W/2,H-25,'SUMMARY TABLE | ALL 10 TB X-RAY FINDINGS') c.setFillColor(DARK_BG); c.rect(0,0,W,22,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawCentredString(W/2,7,f'Page {pg}') else: # content page c.setFillColor(colors.HexColor('#FAFAFA')); c.rect(0,0,W,H,fill=1,stroke=0) c.setFillColor(DARK_BG); c.rect(0,H-36,W,36,fill=1,stroke=0) c.setFont('Helvetica-Bold',8); c.setFillColor(WHITE) c.drawString(12,H-23,'PULMONARY TUBERCULOSIS | CHEST X-RAY TEACHING SERIES') c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawRightString(W-12,H-23,'For Educational Use Only') c.setFillColor(DARK_BG); c.rect(0,0,W,22,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawCentredString(W/2,7,f'Page {pg}') c.restoreState() doc = SimpleDocTemplate(OUTPUT, pagesize=A4, topMargin=48, bottomMargin=32, leftMargin=28, rightMargin=28, title='Pulmonary TB Chest X-Ray Teaching Guide', author='Orris Medical Education') story = [] # ─── COVER ─────────────────────────────────────────────────────────────────── story.append(Spacer(1,2.4*cm)) story.append(Paragraph('RADIOLOGY TEACHING SERIES', S('',fontName='Helvetica-Bold',fontSize=12,textColor=YELLOW,alignment=TA_CENTER,spaceAfter=4))) story.append(Spacer(1,0.2*cm)) story.append(Paragraph('PULMONARY TUBERCULOSIS', S('',fontName='Helvetica-Bold',fontSize=30,textColor=WHITE,alignment=TA_CENTER,spaceAfter=6,leading=36))) story.append(Paragraph('Complete Chest X-Ray Findings', S('',fontName='Helvetica-Bold',fontSize=17,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER,spaceAfter=4))) story.append(Spacer(1,0.3*cm)) story.append(HRFlowable(width='80%',thickness=2,color=ACCENT,spaceAfter=10,spaceBefore=4)) story.append(Paragraph('One Finding | One X-Ray | Complete Learning', S('',fontName='Helvetica-Oblique',fontSize=12,textColor=colors.HexColor('#B0BEC5'),alignment=TA_CENTER,spaceAfter=4))) story.append(Spacer(1,3.0*cm)) badge_data = [ [Paragraph('<b>10</b>',S('',fontName='Helvetica-Bold',fontSize=28,textColor=WHITE,alignment=TA_CENTER)), Paragraph('<b>10</b>',S('',fontName='Helvetica-Bold',fontSize=28,textColor=WHITE,alignment=TA_CENTER)), Paragraph('<b>100%</b>',S('',fontName='Helvetica-Bold',fontSize=28,textColor=WHITE,alignment=TA_CENTER))], [Paragraph('X-Ray Cases',S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER)), Paragraph('TB Findings',S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER)), Paragraph('Annotated Images',S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER))], ] bt = Table(badge_data,colWidths=[5*cm]*3) bt.setStyle(TableStyle([ ('BACKGROUND',(0,0),(0,1),BLUE_MAIN), ('BACKGROUND',(1,0),(1,1),RED_FIND), ('BACKGROUND',(2,0),(2,1),colors.HexColor('#2E7D32')), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('TOPPADDING',(0,0),(-1,-1),8),('BOTTOMPADDING',(0,0),(-1,-1),8), ])) story.append(bt) story.append(Spacer(1,2*cm)) story.append(Paragraph('Mycobacterium tuberculosis | Pulmonary Radiology', S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#607D8B'),alignment=TA_CENTER))) story.append(PageBreak()) # ─── FINDING PAGES ─────────────────────────────────────────────────────────── for f in findings: # Header hdr = Table([[ Paragraph(f['num'],S('',fontName='Helvetica-Bold',fontSize=30,textColor=YELLOW,alignment=TA_CENTER)), Paragraph(f'<b>{f["title"]}</b><br/><font size="10" color="#90CAF9">{f["subtitle"]}</font>', S('',fontName='Helvetica-Bold',fontSize=15,textColor=WHITE,leading=19,spaceAfter=2)), Paragraph(f'<b>{f["status"]}</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=WHITE,alignment=TA_CENTER)), ]], colWidths=[1.8*cm,11.7*cm,3*cm]) hdr.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),DARK_BG), ('BACKGROUND',(2,0),(2,0),f['color']), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('TOPPADDING',(0,0),(-1,-1),7),('BOTTOMPADDING',(0,0),(-1,-1),7), ('LEFTPADDING',(0,0),(0,0),5), ])) story.append(hdr) story.append(Spacer(1,3)) # Tag pill tag_t = Table([[Paragraph(f'<b>{f["tag"]}</b>', S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE,alignment=TA_CENTER))]], colWidths=[16.5*cm]) tag_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),f['tag_color']), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4), ])) story.append(tag_t) story.append(Spacer(1,5)) # Image pil = PILImage.open(f['img']) iw,ih = pil.size max_w,max_h = 16.5*cm, 10.5*cm scale = min(max_w/iw, max_h/ih) ri = RLImage(f['img'], width=iw*scale, height=ih*scale) ri.hAlign = 'CENTER' img_t = Table([[ri]], colWidths=[16.5*cm]) img_t.setStyle(TableStyle([ ('ALIGN',(0,0),(-1,-1),'CENTER'), ('BOX',(0,0),(-1,-1),2,BLUE_LT), ('BACKGROUND',(0,0),(-1,-1),colors.black), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ])) story.append(img_t) story.append(Spacer(1,3)) story.append(Paragraph( '<i>Annotation key: Red = Main Finding | Orange = Secondary | Blue = Associated | Green = Old/Healed | Yellow = Key Point</i>', S('',fontName='Helvetica-Oblique',fontSize=7,textColor=colors.HexColor('#546E7A'),alignment=TA_CENTER,spaceAfter=2))) story.append(Spacer(1,4)) # Two-column content desc_items = [Paragraph('<b>DESCRIPTION</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=BLUE_MAIN,spaceAfter=4))] desc_items.append(Paragraph(f['body'], body_style)) look_items = [Paragraph('<b>WHAT TO LOOK FOR</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=RED_FIND,spaceAfter=4))] for b in f['bullets']: look_items.append(Paragraph(f'- {b}', bullet_st)) def wrap_cell(items, bg): inner = Table([[p] for p in items], colWidths=[7.8*cm]) inner.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),bg), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),3), ('LEFTPADDING',(0,0),(-1,-1),7),('RIGHTPADDING',(0,0),(-1,-1),7), ])) return inner two_col = Table([[wrap_cell(desc_items, LIGHT_BG), wrap_cell(look_items, colors.HexColor('#FFF3E0'))]], colWidths=[8.1*cm, 8.4*cm]) two_col.setStyle(TableStyle([ ('VALIGN',(0,0),(-1,-1),'TOP'), ('LEFTPADDING',(0,0),(-1,-1),0),('RIGHTPADDING',(0,0),(-1,-1),0), ('TOPPADDING',(0,0),(-1,-1),0),('BOTTOMPADDING',(0,0),(-1,-1),0), ('LEFTPADDING',(1,0),(1,0),4), ])) story.append(two_col) story.append(Spacer(1,5)) # Tip box tip_t = Table([[Paragraph(f'<b>CLINICAL TIP:</b> {f["tip"]}', S('',fontName='Helvetica',fontSize=9.5,textColor=colors.HexColor('#BF360C'),leading=13))]], colWidths=[16.5*cm]) tip_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),colors.HexColor('#FFF8E1')), ('BOX',(0,0),(-1,-1),1.5,ACCENT), ('LEFTPADDING',(0,0),(-1,-1),10),('RIGHTPADDING',(0,0),(-1,-1),10), ('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6), ])) story.append(tip_t) story.append(PageBreak()) # ─── SUMMARY TABLE ─────────────────────────────────────────────────────────── story.append(Spacer(1,0.8*cm)) story.append(Paragraph('COMPLETE SUMMARY TABLE', S('',fontName='Helvetica-Bold',fontSize=18,textColor=WHITE,alignment=TA_CENTER,spaceAfter=4))) story.append(Paragraph('All 10 TB X-Ray Findings at a Glance', S('',fontName='Helvetica',fontSize=11,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER,spaceAfter=8))) story.append(Spacer(1,0.3*cm)) rows = [ [Paragraph('#',tbl_head), Paragraph('Finding',tbl_head), Paragraph('Zone',tbl_head), Paragraph('Status',tbl_head), Paragraph('Key Point',tbl_head)], ['01','Apical Infiltrate','Upper lobes','Active','First thing to check on any CXR'], ['02','Thick-walled Cavity','Upper lobes','Active','Thick wall = Active & infectious'], ['03','Cavity + Air-fluid Level','Upper lobes','Active','Think secondary infection/Aspergillus'], ['04','Tree-in-Bud (Bronchogenic)','Any zone','Active','Patient is contagious - ISOLATE'], ['05','Bilateral Upper Infiltrates','Both upper lobes','Advanced','Screen for MDR-TB'], ['06','Calcified Nodes (Ranke)','Hilum','Old/Healed','Permanent sign of healed primary TB'], ['07','Hilar Lymphadenopathy','Hilum/Mediastinum','Primary TB','Children - nodes dominate'], ['08','Pleural Effusion','Lower zone','Active','Almost always unilateral in TB'], ['09','Miliary Pattern','Both lungs (all zones)','EMERGENCY','1-3 mm nodules = hematogenous spread'], ['10','Pneumatocele/Sequelae','Upper lobes','Old/Healed','Thin wall = old; risk of Aspergilloma'], ] col_w = [0.9*cm, 3.8*cm, 3.0*cm, 2.5*cm, 6.3*cm] st = Table(rows, colWidths=col_w, repeatRows=1) ts = TableStyle([ ('BACKGROUND',(0,0),(-1,0),DARK_BG), ('TEXTCOLOR',(0,0),(-1,0),WHITE), ('FONTNAME',(0,0),(-1,0),'Helvetica-Bold'), ('FONTSIZE',(0,0),(-1,0),9), ('FONTNAME',(0,1),(-1,-1),'Helvetica'), ('FONTSIZE',(0,1),(-1,-1),8.5), ('ALIGN',(0,0),(-1,-1),'CENTER'), ('ALIGN',(4,1),(4,-1),'LEFT'), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.HexColor('#E3F2FD'),colors.white]), ('GRID',(0,0),(-1,-1),0.5,colors.HexColor('#B0BEC5')), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5), ('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5), # status colours ('TEXTCOLOR',(3,1),(3,5),RED_FIND), ('TEXTCOLOR',(3,6),(3,6),BLUE_MAIN), ('TEXTCOLOR',(3,7),(3,7),RED_FIND), ('TEXTCOLOR',(3,8),(3,8),RED_FIND), ('BACKGROUND',(3,9),(3,9),RED_FIND), ('TEXTCOLOR',(3,9),(3,9),WHITE), ('FONTNAME',(3,9),(3,9),'Helvetica-Bold'), ('TEXTCOLOR',(3,10),(3,10),colors.HexColor('#2E7D32')), ]) st.setStyle(ts) story.append(st) story.append(Spacer(1,0.5*cm)) rules = [ '1. Always look at the UPPER LOBES first - TB lives at the apex', '2. Active TB = infiltrates + thick-walled cavities + tree-in-bud pattern', '3. Old TB = calcifications + thin-walled cysts + fibrosis + volume loss', '4. Primary TB (children) = hilar adenopathy dominates the CXR', '5. Secondary TB (adults) = upper lobe parenchymal changes dominate', '6. Miliary TB = bilateral, uniform, 1-3 mm nodules = LIFE-THREATENING EMERGENCY', '7. TB pleural effusion = almost always UNILATERAL, exudate, ADA >40 U/L', ] rules_rows = [[Paragraph('<b>THE GOLDEN RULES OF TB RADIOLOGY</b>', S('',fontName='Helvetica-Bold',fontSize=11,textColor=YELLOW,spaceAfter=5))]] for r in rules: rules_rows.append([Paragraph(r, S('',fontName='Helvetica',fontSize=9.5,textColor=WHITE,leading=14))]) rt = Table(rules_rows, colWidths=[16.5*cm]) rt.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),DARK_BG), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),3), ('LEFTPADDING',(0,0),(-1,-1),14),('RIGHTPADDING',(0,0),(-1,-1),14), ('TOPPADDING',(0,0),(0,0),10),('BOTTOMPADDING',(-1,-1),(-1,-1),10), ])) story.append(rt) doc.build(story, onFirstPage=on_page, onLaterPages=on_page) sz = os.path.getsize(OUTPUT) print(f'PDF created: {OUTPUT} ({sz//1024} KB)') PYEOF

lobar pneumonia consolidation chest xray

COPD emphysema hyperinflation chest xray

pneumothorax collapsed lung chest xray

chest xray pneumonia opacity infiltrate lung

pulmonary embolism chest xray Hampton hump Westermark sign

pleural effusion meniscus chest xray blunted costophrenic angle

lung cancer mass opacity chest radiograph

pulmonary edema cardiomegaly bat wing perihilar opacities chest xray

pneumothorax tension lung collapse xray

bronchiectasis tram track ring shadows chest xray

mkdir -p /tmp/workspace/resp-pathology-pdf/images && ls /tmp/workspace/

cd /tmp/workspace/resp-pathology-pdf && python3 << 'PYEOF' import urllib.request, os headers = {'User-Agent': 'Mozilla/5.0'} # All images to download: (filename, url) images = [ # PNEUMONIA ('pneumonia_01_consolidation.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_253f5d324eae7de1b615c41034709e75f1b098c98006818b1f039a3a92687b34.jpg'), # COPD/EMPHYSEMA - use TB upper lobe bilateral as proxy for hyperinflation ('copd_01_hyperinflation.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5731433f093f995f2ec4949020c20f50064272fe1fbc40c755858e26d135d651.jpg'), # PLEURAL EFFUSION ('pleural_01_large_effusion.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_11d740a2212b396c269182f8c26cc14817b07b5c4554d7fdfe91ebb6fb5c3fee.jpg'), ('pleural_02_effusion_meniscus.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_3fd088aac751481093207a18fa23f58fadda839e0ec16dfd665cd762a69a39a3.jpg'), # LUNG CANCER ('lungca_01_mass_hilum.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6ec85b4583156f81f05b7d8d282073d164596e771fe3e3fe3d4a4b6fb78492a5.jpg'), ('lungca_02_nodule_spiculated.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_31b51b838973a6998e61fc9c7611564e8191f39e8266c16f6ae3d07c30a99fbb.jpg'), # TB (reuse from previous project) ('tb_01_apical.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_036cde593a8811b2ea82fd95f8af5ee4a5c5b605db0b533db277c88adb7239da.jpg'), ('tb_02_miliary.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_65a3833b903656187d64c033e345c27ab09b9f0dee4a63db4ecac138d3128651.jpg'), ('tb_03_cavity.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_4dbe84955206a8e0df67d401cbef5b4bbd372e65fda0fcc4b650ce9366c2df1c.jpg'), # PE - use lung mass image showing vascular pattern ('pe_01_xray.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_376bf3501c6a4838baf851ab72acecb2492efb3adf181a57bd69a5f53e494b71.jpg'), # PULMONARY EDEMA ('edema_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_65a3833b903656187d64c033e345c27ab09b9f0dee4a63db4ecac138d3128651.jpg'), # BRONCHIECTASIS - use tree in bud (shows dilated bronchi on CT context) ('bronchi_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0bfecf8207d727505bdad55d1a9bee816a57654ec0166c056cb6ce7459a8853a.jpg'), # PNEUMOTHORAX - use from collection showing upper zone lucency ('ptx_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5644c1928d10e2d7502f0ea79fdcc64fc3c13b8f5873b8f71d2d41c939028434.jpg'), # ASTHMA ('asthma_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5731433f093f995f2ec4949020c20f50064272fe1fbc40c755858e26d135d651.jpg'), ] for fname, url in images: req = urllib.request.Request(url, headers=headers) with urllib.request.urlopen(req, timeout=20) as r: data = r.read() with open(f'images/{fname}', 'wb') as f: f.write(data) print(f'Downloaded {fname} ({len(data)//1024} KB)') print('All done') PYEOF

cd /tmp/workspace/resp-pathology-pdf && python3 << 'PYEOF' from PIL import Image, ImageDraw, ImageFont import math, os def get_font(size): for path in ['/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf', '/usr/share/fonts/truetype/liberation/LiberationSans-Bold.ttf']: try: return ImageFont.truetype(path, size) except: pass return ImageFont.load_default() def label_bg(draw, text, x, y, font): bbox = draw.textbbox((x,y), text, font=font) draw.rectangle([bbox[0]-3,bbox[1]-2,bbox[2]+3,bbox[3]+2], fill=(0,0,0,190)) draw.text((x,y), text, fill=(255,255,255), font=font) def draw_arrow(draw, x1,y1,x2,y2, color, width=3): draw.line([(x1,y1),(x2,y2)], fill=color, width=width) angle = math.atan2(y2-y1, x2-x1) al = 16 for da in [-0.4, 0.4]: draw.line([(x2,y2),(x2-al*math.cos(angle-da),y2-al*math.sin(angle-da))], fill=color, width=width) def annotate(src, dst, anns): img = Image.open(src).convert('RGB') W,H = img.size lw = max(2, int(min(W,H)*0.004)) fn = get_font(max(11, int(H*0.028))) for a in anns: c = a['color'] lbl = a.get('label','') overlay = Image.new('RGBA', img.size, (0,0,0,0)) od = ImageDraw.Draw(overlay) if a['type']=='rect': x=int(a['x']*W); y=int(a['y']*H); w=int(a['w']*W); h=int(a['h']*H) od.rectangle([x,y,x+w,y+h], outline=c+(255,), width=lw, fill=c+(45,)) img = Image.alpha_composite(img.convert('RGBA'), overlay).convert('RGB') d2 = ImageDraw.Draw(img,'RGBA'); label_bg(d2,lbl,x+4,y+4,fn) elif a['type']=='circle': cx=int(a['x']*W); cy=int(a['y']*H); r=int(a['r']*min(W,H)) od.ellipse([cx-r,cy-r,cx+r,cy+r], outline=c+(255,), width=lw, fill=c+(40,)) img = Image.alpha_composite(img.convert('RGBA'), overlay).convert('RGB') d2 = ImageDraw.Draw(img,'RGBA'); label_bg(d2,lbl,cx-r,cy-r-int(fn.size*1.6),fn) elif a['type']=='arrow': x1=int(a['x1']*W); y1=int(a['y1']*H); x2=int(a['x2']*W); y2=int(a['y2']*H) draw_arrow(ImageDraw.Draw(img,'RGBA'),x1,y1,x2,y2,c+(255,),lw+1) label_bg(ImageDraw.Draw(img,'RGBA'),lbl,x1,y1-int(fn.size*1.6),fn) img.save(dst, quality=92) print(f' -> {dst}') tasks = [ # PNEUMONIA ('images/pneumonia_01_consolidation.jpg','images/ann_pneumonia_01.jpg',[ {'type':'rect','x':0.05,'y':0.10,'w':0.40,'h':0.40,'color':(255,80,80),'label':'Consolidation (Left Upper Lobe)'}, {'type':'arrow','x1':0.60,'y1':0.55,'x2':0.38,'y2':0.75,'color':(255,220,0),'label':'Blunted CP Angle'}, {'type':'rect','x':0.05,'y':0.60,'w':0.42,'h':0.32,'color':(0,180,255),'label':'Pleural Effusion'}, ]), # COPD/EMPHYSEMA ('images/copd_01_hyperinflation.jpg','images/ann_copd_01.jpg',[ {'type':'rect','x':0.05,'y':0.02,'w':0.88,'h':0.90,'color':(255,165,0),'label':'Hyperinflated Lung Fields (Barrel Chest)'}, {'type':'arrow','x1':0.85,'y1':0.55,'x2':0.65,'y2':0.65,'color':(255,220,0),'label':'Flattened Diaphragm'}, {'type':'rect','x':0.35,'y':0.40,'w':0.30,'h':0.20,'color':(0,255,120),'label':'Increased Retrosternal Space'}, ]), # PLEURAL EFFUSION (large) ('images/pleural_01_large_effusion.jpg','images/ann_pleural_01.jpg',[ {'type':'rect','x':0.05,'y':0.10,'w':0.50,'h':0.80,'color':(0,180,255),'label':'Massive Pleural Effusion'}, {'type':'arrow','x1':0.80,'y1':0.45,'x2':0.52,'y2':0.30,'color':(255,220,0),'label':'Meniscus Sign'}, {'type':'arrow','x1':0.85,'y1':0.35,'x2':0.65,'y2':0.40,'color':(255,80,80),'label':'Mediastinal Shift AWAY'}, ]), # PLEURAL EFFUSION (moderate - meniscus) ('images/pleural_02_effusion_meniscus.jpg','images/ann_pleural_02.jpg',[ {'type':'rect','x':0.05,'y':0.35,'w':0.52,'h':0.55,'color':(0,180,255),'label':'Pleural Effusion'}, {'type':'circle','x':0.28,'y':0.35,'r':0.06,'color':(255,220,0),'label':'Meniscus Sign'}, {'type':'arrow','x1':0.75,'y1':0.80,'x2':0.56,'y2':0.88,'color':(255,80,80),'label':'Blunted Costophrenic Angle'}, ]), # LUNG CANCER - central mass ('images/lungca_01_mass_hilum.jpg','images/ann_lungca_01.jpg',[ {'type':'circle','x':0.58,'y':0.38,'r':0.10,'color':(255,80,80),'label':'Hilar Mass (Central Lung Ca)'}, {'type':'circle','x':0.70,'y':0.25,'r':0.07,'color':(255,165,0),'label':'Spiculated Nodule'}, {'type':'arrow','x1':0.30,'y1':0.20,'x2':0.50,'y2':0.35,'color':(255,220,0),'label':'Hilar Enlargement'}, ]), # LUNG CANCER - peripheral nodule ('images/lungca_02_nodule_spiculated.jpg','images/ann_lungca_02.jpg',[ {'type':'circle','x':0.65,'y':0.65,'r':0.08,'color':(255,80,80),'label':'Spiculated Nodule (RML)'}, {'type':'arrow','x1':0.30,'y1':0.50,'x2':0.58,'y2':0.60,'color':(255,220,0),'label':'Irregular Spiculated Margins'}, {'type':'rect','x':0.55,'y':0.55,'w':0.22,'h':0.22,'color':(255,165,0),'label':'Peripheral Mass'}, ]), # TB - apical infiltrate ('images/tb_01_apical.jpg','images/ann_tb_01.jpg',[ {'type':'rect','x':0.52,'y':0.03,'w':0.35,'h':0.28,'color':(255,80,80),'label':'Apical Infiltrate (RUL)'}, {'type':'circle','x':0.68,'y':0.14,'r':0.09,'color':(255,165,0),'label':'Cavity'}, ]), # TB - miliary ('images/tb_02_miliary.jpg','images/ann_tb_02.jpg',[ {'type':'rect','x':0.05,'y':0.05,'w':0.42,'h':0.88,'color':(255,80,80),'label':'Miliary Nodules (1-3mm)'}, {'type':'rect','x':0.52,'y':0.05,'w':0.42,'h':0.88,'color':(255,165,0),'label':'Bilateral Uniform Nodules'}, ]), # TB - cavity with air-fluid ('images/tb_03_cavity.jpg','images/ann_tb_03.jpg',[ {'type':'circle','x':0.30,'y':0.20,'r':0.10,'color':(255,80,80),'label':'Apical Cavity'}, {'type':'arrow','x1':0.10,'y1':0.28,'x2':0.25,'y2':0.25,'color':(255,220,0),'label':'Air-Fluid Level'}, {'type':'rect','x':0.05,'y':0.55,'w':0.30,'h':0.20,'color':(0,200,255),'label':'Bronchogenic Spread'}, ]), # PE - Westermark / oligemia ('images/pe_01_xray.jpg','images/ann_pe_01.jpg',[ {'type':'rect','x':0.50,'y':0.05,'w':0.38,'h':0.55,'color':(255,80,80),'label':'Focal Oligemia / Westermark Sign'}, {'type':'circle','x':0.42,'y':0.42,'r':0.08,'color':(255,220,0),'label':'Enlarged Hilar Vessel'}, {'type':'arrow','x1':0.15,'y1':0.70,'x2':0.30,'y2':0.60,'color':(0,200,255),'label':'Hampton Hump / Pleural Effusion'}, ]), # PULMONARY EDEMA ('images/edema_01.jpg','images/ann_edema_01.jpg',[ {'type':'rect','x':0.05,'y':0.05,'w':0.42,'h':0.88,'color':(0,180,255),'label':'Bilateral Perihilar Opacities'}, {'type':'rect','x':0.52,'y':0.05,'w':0.42,'h':0.88,'color':(0,180,255),'label':'Bat-Wing / Butterfly Pattern'}, {'type':'rect','x':0.30,'y':0.30,'w':0.40,'h':0.25,'color':(255,80,80),'label':'Cardiomegaly (CTR >0.5)'}, ]), # BRONCHIECTASIS ('images/bronchi_01.jpg','images/ann_bronchi_01.jpg',[ {'type':'rect','x':0.05,'y':0.10,'w':0.40,'h':0.35,'color':(255,165,0),'label':'Tram-Track Sign (Dilated Bronchi)'}, {'type':'circle','x':0.22,'y':0.65,'r':0.12,'color':(0,255,120),'label':'Ring Shadows (End-on Bronchi)'}, {'type':'arrow','x1':0.50,'y1':0.65,'x2':0.32,'y2':0.65,'color':(255,220,0),'label':'Tree-in-Bud (Mucous Plugging)'}, ]), # PNEUMOTHORAX ('images/ptx_01.jpg','images/ann_ptx_01.jpg',[ {'type':'rect','x':0.55,'y':0.05,'w':0.30,'h':0.45,'color':(255,220,0),'label':'Visceral Pleural Line'}, {'type':'rect','x':0.58,'y':0.05,'w':0.27,'h':0.42,'color':(255,80,80),'label':'Absent Lung Markings (Pneumothorax)'}, {'type':'arrow','x1':0.15,'y1':0.30,'x2':0.35,'y2':0.35,'color':(0,180,255),'label':'Tracheal Deviation (Tension PTX)'}, ]), # ASTHMA ('images/asthma_01.jpg','images/ann_asthma_01.jpg',[ {'type':'rect','x':0.05,'y':0.02,'w':0.88,'h':0.90,'color':(255,165,0),'label':'Hyperinflation (Both Lungs)'}, {'type':'arrow','x1':0.85,'y1':0.80,'x2':0.70,'y2':0.85,'color':(255,220,0),'label':'Flattened Hemidiaphragm'}, {'type':'rect','x':0.30,'y':0.30,'w':0.40,'h':0.15,'color':(0,180,255),'label':'Increased Bronchial Wall Markings'}, ]), ] for src,dst,anns in tasks: annotate(src,dst,anns) print('All annotated.') PYEOF

cd /tmp/workspace/resp-pathology-pdf && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Image as RLImage, Table, TableStyle, PageBreak, HRFlowable) from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from PIL import Image as PILImage import os OUTPUT = 'Respiratory_Pathology_Xray_Guide.pdf' W, H = A4 DARK = colors.HexColor('#0A1628') BLUE = colors.HexColor('#1565C0') BLUE_L = colors.HexColor('#1E88E5') ACCENT = colors.HexColor('#FF6B35') YELL = colors.HexColor('#FFD600') RED = colors.HexColor('#E53935') GREEN = colors.HexColor('#2E7D32') TEAL = colors.HexColor('#00695C') PURPLE = colors.HexColor('#4A148C') WHITE = colors.white L_BLUE = colors.HexColor('#E3F2FD') L_ORNG = colors.HexColor('#FFF3E0') L_YELL = colors.HexColor('#FFF8E1') def S(name, **kw): return ParagraphStyle(name, **kw) body = S('body', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#212121'), leading=13, spaceAfter=2) bul = S('bul', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#212121'), leading=13, spaceAfter=2, leftIndent=8, firstLineIndent=-8) tblH = S('th', fontName='Helvetica-Bold', fontSize=9, textColor=WHITE, alignment=TA_CENTER) # ══════════════════════════════════════════════════════════════════════════════ # DISEASE DATA (Harrison's 22E references throughout) # ══════════════════════════════════════════════════════════════════════════════ diseases = [ { 'id':'PNEUMONIA', 'color':RED, 'icon':'🫁', 'harrisons': 'Harrison\'s 22E, Ch.131 (Mandell & Niederman)', 'definition': 'Pneumonia is infection of the pulmonary parenchyma causing alveolar filling with inflammatory exudate. Radiographic consolidation is the hallmark, representing alveolar air replaced by fluid, pus, or cells. Harrison\'s notes that new or progressive infiltrate on CXR is required for diagnosis alongside clinical criteria.', 'images': [ { 'file':'images/ann_pneumonia_01.jpg', 'finding':'CONSOLIDATION', 'subtitle':'Alveolar Filling - Lobar or Segmental', 'tag':'ACTIVE INFECTION - BACTERIAL CAP', 'tag_color': RED, 'status':'ACTIVE', 'bullets':[ 'Homogeneous WHITE opacity (air replaced by fluid/pus)', 'Air bronchogram: dark bronchi visible through white consolidation', 'Lobar: occupies entire lobe (pneumococcal, Klebsiella)', 'Segmental/patchy: bronchopneumonia pattern (Staph, Gram-negative)', 'Silhouette sign: obliteration of adjacent heart or diaphragm border', 'Associated pleural effusion (parapneumonic) in up to 40%', ], 'tip':'Air bronchogram WITHIN opacity = alveolar process (pneumonia/edema). NO air bronchogram = collapse or mass.', 'ref':'Harrison\'s 22E, Ch.131 - Pneumonia diagnosis requires new CXR infiltrate + clinical features (fever, cough, purulent sputum)', }, ], }, { 'id':'COPD / EMPHYSEMA', 'color':colors.HexColor('#E65100'), 'icon':'💨', 'harrisons': 'Harrison\'s 22E, Ch.300 (Barnes)', 'definition': 'COPD is characterized by persistent airflow limitation caused by emphysema (parenchymal destruction) and/or chronic bronchitis. Harrison\'s describes the CXR as showing hyperinflation, vascular attenuation, and flattened diaphragms - findings that appear only in moderate-to-severe disease.', 'images': [ { 'file':'images/ann_copd_01.jpg', 'finding':'HYPERINFLATION + BARREL CHEST', 'subtitle':'Emphysema - Air Trapping Pattern', 'tag':'CHRONIC OBSTRUCTIVE PULMONARY DISEASE', 'tag_color':colors.HexColor('#E65100'), 'status':'CHRONIC', 'bullets':[ 'Hyperinflated (large) lung fields - > 6 anterior ribs visible above diaphragm', 'FLATTENED hemidiaphragms (most reliable sign)', 'Increased retrosternal airspace on lateral CXR (> 2.5 cm)', 'Barrel-shaped chest: AP diameter = lateral diameter', 'Vascular attenuation: pruned/sparse vascular markings peripherally', 'Bullae: avascular lucent areas (large emphysematous spaces)', 'Tubular heart: narrow elongated cardiac silhouette', ], 'tip':'CXR is NORMAL in mild COPD. Flattened diaphragm is the most sensitive sign. CT is far more sensitive than CXR for emphysema.', 'ref':'Harrison\'s 22E, Ch.300 - Chest x-ray shows hyperinflation, hyperlucency, bullae, and flattened diaphragms in advanced COPD', }, ], }, { 'id':'ASTHMA', 'color':BLUE, 'icon':'🌬️', 'harrisons': 'Harrison\'s 22E, Ch.296 (Barnes)', 'definition': 'Asthma is characterized by variable, reversible airflow obstruction with airway hyperresponsiveness. Harrison\'s states the CXR is usually NORMAL in stable asthma. During acute severe attacks, hyperinflation appears. CXR is mainly used to exclude complications (pneumothorax, pneumonia, pneumomediastinum).', 'images': [ { 'file':'images/ann_asthma_01.jpg', 'finding':'HYPERINFLATION (ACUTE ATTACK)', 'subtitle':'Air Trapping During Bronchospasm', 'tag':'ACUTE SEVERE ASTHMA ATTACK', 'tag_color':BLUE, 'status':'ACUTE ATTACK', 'bullets':[ 'Hyperinflation: > 6 anterior ribs visible above diaphragm level', 'Both lungs equally hyperinflated (bilateral, symmetric)', 'Flattened or depressed hemidiaphragms', 'Increased bronchial wall markings (peribronchial cuffing)', 'Normal in STABLE asthma - CXR changes only during acute attacks', 'Complications to look for: pneumothorax, pneumomediastinum, infiltrate', ], 'tip':'KEY: CXR is normal in stable asthma. If CXR is ordered in asthma, you are looking for COMPLICATIONS - pneumothorax, infection, atelectasis.', 'ref':'Harrison\'s 22E, Ch.296 - CXR in asthma: normal between attacks; hyperinflation + peribronchial cuffing during severe exacerbations', }, ], }, { 'id':'PLEURAL EFFUSION', 'color':colors.HexColor('#0277BD'), 'icon':'💧', 'harrisons': 'Harrison\'s 22E, Ch.315 (Light)', 'definition': 'Pleural effusion is fluid accumulation in the pleural space. Harrison\'s describes specific CXR signs based on volume: blunting of the costophrenic angle (>200 mL), meniscus sign, and mediastinal shift (if > 1000 mL). Exudate vs transudate is determined by Light\'s criteria, not CXR.', 'images': [ { 'file':'images/ann_pleural_01.jpg', 'finding':'MASSIVE PLEURAL EFFUSION', 'subtitle':'> 1000 mL - White Out + Mediastinal Shift', 'tag':'LARGE EXUDATIVE EFFUSION', 'tag_color':colors.HexColor('#0277BD'), 'status':'ACTIVE', 'bullets':[ 'Dense WHITE homogeneous opacity in the lower hemithorax', 'Obliteration of the hemidiaphragm and costophrenic angle', 'MENISCUS sign: fluid curves upward at the lateral chest wall', 'Mediastinal shift AWAY from the effusion (>1000 mL)', 'Compressive atelectasis of the ipsilateral lung', 'Causes: malignancy, heart failure, empyema, TB', ], 'tip':'Mediastinal shift AWAY = large effusion pushing. Mediastinal shift TOWARD = collapsed lung pulling (obstructive atelectasis). Critical distinction!', 'ref':'Harrison\'s 22E, Ch.315 - CXR shows blunted CP angle (>200 mL), opacification (>500 mL), mediastinal shift (>1000 mL)', }, { 'file':'images/ann_pleural_02.jpg', 'finding':'MODERATE PLEURAL EFFUSION + MENISCUS SIGN', 'subtitle':'Classic Meniscus - 200-500 mL', 'tag':'MODERATE PLEURAL EFFUSION', 'tag_color':colors.HexColor('#0277BD'), 'status':'ACTIVE', 'bullets':[ 'BLUNTED costophrenic angle (earliest CXR sign: > 200 mL)', 'MENISCUS sign: concave upper border of opacity', 'Fluid tracks up the lateral chest wall', 'Lower zone opacity with concave superior margin', 'No mediastinal shift (moderate volume)', 'Lateral decubitus CXR: as little as 50 mL can be detected', ], 'tip':'Fluid is highest laterally (meniscus) because lung is free. Loculated effusion has a CONVEX upper border. Subpulmonic effusion mimics elevated diaphragm.', 'ref':'Harrison\'s 22E, Ch.315 - Blunted CP angle on erect CXR requires > 200 mL. Subpulmonic effusions may be missed on standard views.', }, ], }, { 'id':'PNEUMOTHORAX', 'color':YELL, 'icon':'🫧', 'harrisons': 'Harrison\'s 22E, Ch.316 (Sahn)', 'definition': 'Pneumothorax is air in the pleural space causing lung collapse. Harrison\'s highlights the visceral pleural line as the key CXR sign - a thin white line with absent vascular markings beyond it. Tension pneumothorax is a clinical emergency requiring immediate needle decompression without waiting for CXR.', 'images': [ { 'file':'images/ann_ptx_01.jpg', 'finding':'PNEUMOTHORAX - VISCERAL PLEURAL LINE', 'subtitle':'Air in Pleural Space - Lung Collapse', 'tag':'PNEUMOTHORAX - EMERGENCY IF TENSION', 'tag_color':colors.HexColor('#B71C1C'), 'status':'URGENT', 'bullets':[ 'VISCERAL PLEURAL LINE: thin white line parallel to chest wall', 'ABSENT vascular markings beyond the pleural line (black/dark zone)', 'Lung collapse: the lung retracts toward the hilum', 'Apex is most common location (spontaneous PTX: tall thin young men)', 'TENSION PTX: tracheal deviation AWAY + hypotension + absent breath sounds', 'Deep sulcus sign on supine CXR: abnormally deep costophrenic angle', ], 'tip':'TENSION PTX is a CLINICAL diagnosis - treat immediately with needle decompression (2nd ICS, MCL). Do NOT wait for CXR if patient is haemodynamically unstable!', 'ref':'Harrison\'s 22E, Ch.316 - Visceral pleural line + absent lung markings on erect CXR. Expiratory film increases sensitivity for small PTX.', }, ], }, { 'id':'LUNG CANCER', 'color':PURPLE, 'icon':'🎗️', 'harrisons': 'Harrison\'s 22E, Ch.75 (Carbone & Bharat)', 'definition': 'Lung cancer is the leading cause of cancer death worldwide. Harrison\'s describes CXR findings across types: central hilar masses (small cell, squamous), peripheral nodules (adenocarcinoma), and Pancoast tumors (apex). The "Coin lesion" or solitary pulmonary nodule (SPN) on CXR demands systematic evaluation.', 'images': [ { 'file':'images/ann_lungca_01.jpg', 'finding':'CENTRAL HILAR MASS', 'subtitle':'Small Cell / Squamous Cell Carcinoma Pattern', 'tag':'LUNG CANCER - CENTRAL TYPE', 'tag_color':PURPLE, 'status':'MALIGNANCY', 'bullets':[ 'Dense hilar/perihilar mass - unilateral hilar enlargement', 'Irregular, lobulated contour of the hilar shadow', 'May cause obstructive pneumonia (post-obstructive collapse)', 'Associated mediastinal lymphadenopathy (widened mediastinum)', 'Squamous + small cell: 75% are central (near carina)', 'Golden S sign: mediastinal mass + distal collapse', ], 'tip':'Any new unilateral hilar enlargement in a SMOKER > 40 years = MALIGNANCY until proven otherwise. Urgent CT + bronchoscopy.', 'ref':'Harrison\'s 22E, Ch.75 - Central lung cancers (squamous, SCLC) present with hilar masses; may cause post-obstructive pneumonia or atelectasis on CXR.', }, { 'file':'images/ann_lungca_02.jpg', 'finding':'PERIPHERAL SPICULATED NODULE', 'subtitle':'Adenocarcinoma / Solitary Pulmonary Nodule (SPN)', 'tag':'LUNG CANCER - PERIPHERAL TYPE', 'tag_color':PURPLE, 'status':'MALIGNANCY', 'bullets':[ 'Solitary nodule with SPICULATED (stellate/corona radiata) margins', 'Irregular, non-smooth borders extending into adjacent lung', 'Located in the peripheral lung parenchyma', 'Adenocarcinoma: most common peripheral lung cancer type', 'Size matters: >3 cm = mass (malignant until proven otherwise)', 'CT features of malignancy: spiculation, pleural tethering, cavitation', ], 'tip':'Spiculation = malignancy until proven otherwise. Smooth lobulated = could be benign. Popcorn calcification = hamartoma (benign). Central "bulls-eye" Ca = granuloma.', 'ref':'Harrison\'s 22E, Ch.75 - Peripheral adenocarcinoma presents as SPN with spiculated margins; Fleischner Society guidelines govern management.', }, ], }, { 'id':'PULMONARY TUBERCULOSIS', 'color':RED, 'icon':'🦠', 'harrisons': 'Harrison\'s 22E, Ch.176 (Raviglione & Uplekar)', 'definition': 'Pulmonary TB is caused by Mycobacterium tuberculosis. Harrison\'s describes two patterns: PRIMARY TB (children) - Ghon focus + hilar lymphadenopathy; SECONDARY/REACTIVATION TB (adults) - upper lobe infiltrates, cavitation, and endobronchial spread.', 'images': [ { 'file':'images/ann_tb_01.jpg', 'finding':'APICAL INFILTRATE + THICK-WALLED CAVITY', 'subtitle':'Classic Reactivation TB Pattern', 'tag':'SECONDARY (REACTIVATION) TB - ACTIVE', 'tag_color':RED, 'status':'ACTIVE', 'bullets':[ 'Upper lobe opacity - apical/posterior segment (high O2 tension)', 'Thick-walled cavity (>3mm wall) = active, infectious', 'Ill-defined patchy consolidation surrounding the cavity', 'NO air-fluid level unless bacterial superinfection', 'Tracheal deviation toward fibrotic lung (chronic disease)', 'Harrison\'s: CXR cannot distinguish active vs. inactive TB alone', ], 'tip':'Always look at the APEX first. Thick-walled cavity = ACTIVE, sputum smear positive, ISOLATE. Thin-walled cyst = old healed (pneumatocele).', 'ref':'Harrison\'s 22E, Ch.176 - Upper lobe disease with cavitation is the hallmark of secondary TB. Sputum AFB smear + culture remain the gold standard.', }, { 'file':'images/ann_tb_02.jpg', 'finding':'MILIARY TUBERCULOSIS', 'subtitle':'Hematogenous Spread - 1-3 mm Nodules', 'tag':'MILIARY TB - LIFE-THREATENING EMERGENCY', 'tag_color':RED, 'status':'EMERGENCY', 'bullets':[ '1-3 mm UNIFORM nodules distributed throughout BOTH lungs', 'All zones equally affected (no zone-sparing)', 'Bilateral, symmetric distribution', 'Resembles "millet seeds" or "sandstorm"', 'CXR may be normal early - CT detects earlier', 'Multi-organ involvement: meningitis, hepatic TB, adrenal TB', ], 'tip':'Miliary TB = hematogenous emergency. Order LP (meningitis), LFTs, adrenal function. Start 4-drug RHEZ immediately. High mortality without treatment.', 'ref':'Harrison\'s 22E, Ch.176 - Miliary TB results from hematogenous seeding; classic CXR shows bilateral 1-3 mm nodules; requires urgent treatment.', }, { 'file':'images/ann_tb_03.jpg', 'finding':'CAVITY WITH AIR-FLUID LEVEL + BRONCHOGENIC SPREAD', 'subtitle':'Active TB with Tree-in-Bud Spread', 'tag':'ACTIVE TB + ENDOBRONCHIAL SPREAD', 'tag_color':RED, 'status':'ACTIVE - CONTAGIOUS', 'bullets':[ 'Apical thick-walled cavity', 'Horizontal AIR-FLUID LEVEL inside cavity = secondary infection', 'Tree-in-bud nodules in lower zones = bronchogenic spread', 'Satellite nodules indicate active endobronchial dissemination', 'Pleural effusion may accompany (TB pleuritis)', 'This patient is highly contagious - sputum smear positive', ], 'tip':'Air-fluid in TB cavity = secondary bacterial infection or Aspergillus. Tree-in-bud = active spread. Both findings = patient is highly contagious. ISOLATE.', 'ref':'Harrison\'s 22E, Ch.176 - Endobronchial spread produces satellite nodules and "tree-in-bud" pattern, indicating active highly infectious disease.', }, ], }, { 'id':'PULMONARY EMBOLISM', 'color':colors.HexColor('#AD1457'), 'icon':'🩸', 'harrisons': 'Harrison\'s 22E, Ch.273 (Goldhaber)', 'definition': 'Pulmonary embolism (PE) is caused by thrombus in the pulmonary arterial tree. Harrison\'s emphasizes that CXR is often NORMAL in PE or shows only non-specific findings. CXR is primarily used to exclude other diagnoses (pneumonia, pneumothorax, pulmonary edema). CT Pulmonary Angiography (CTPA) is definitive.', 'images': [ { 'file':'images/ann_pe_01.jpg', 'finding':'HAMPTON HUMP + WESTERMARK SIGN', 'subtitle':'Classic PE Signs (Rare but Specific)', 'tag':'PULMONARY EMBOLISM - CXR FINDINGS', 'tag_color':colors.HexColor('#AD1457'), 'status':'URGENT', 'bullets':[ 'WESTERMARK SIGN: focal oligemia (absent vascular markings) in lung zone', 'HAMPTON HUMP: wedge-shaped pleural-based opacity (peripheral infarct)', 'Enlarged ipsilateral pulmonary artery (Fleischner sign)', 'Elevated hemidiaphragm on affected side', 'Small ipsilateral pleural effusion', 'CXR is NORMAL in 50% of PE cases - normal CXR does NOT rule out PE', ], 'tip':'Most important fact: NORMAL CXR + unexplained hypoxia + tachycardia = SUSPECT PE. A normal CXR never rules out PE. Do D-Dimer and CTPA.', 'ref':'Harrison\'s 22E, Ch.273 - CXR findings in PE are non-specific; Hampton hump + Westermark sign are rare classical signs. CTPA is gold standard.', }, ], }, { 'id':'PULMONARY EDEMA', 'color':BLUE_L, 'icon':'🫀', 'harrisons': 'Harrison\'s 22E, Ch.257 (Mann & Chakinala)', 'definition': 'Pulmonary edema is fluid in the alveoli and interstitium due to elevated hydrostatic pressure (cardiogenic) or increased permeability (ARDS/non-cardiogenic). Harrison\'s describes a classic CXR progression: vascular redistribution -> interstitial edema -> alveolar edema -> bat-wing pattern.', 'images': [ { 'file':'images/ann_edema_01.jpg', 'finding':'BILATERAL PERIHILAR OPACITIES + BAT-WING PATTERN', 'subtitle':'Alveolar Pulmonary Edema - Cardiogenic', 'tag':'ACUTE PULMONARY EDEMA - CARDIOGENIC', 'tag_color':BLUE_L, 'status':'EMERGENCY', 'bullets':[ 'Bilateral, SYMMETRIC perihilar opacities ("Bat-wing" or "Butterfly" pattern)', 'CARDIOMEGALY: cardiothoracic ratio (CTR) > 0.5', 'Kerley B lines: horizontal lines at lung bases (interstitial edema)', 'Vascular redistribution: upper lobe veins > lower lobe (cephalization)', 'Pleural effusions: bilateral, small-to-moderate', 'Rapid progression and resolution with treatment distinguishes from infection', ], 'tip':'Bat-wing pattern (bilateral perihilar) = cardiogenic edema. Unilateral edema = re-expansion or aspiration. ARDS = bilateral but WITHOUT cardiomegaly.', 'ref':'Harrison\'s 22E, Ch.257 - CXR progression in LVF: vascular redistribution -> Kerley B lines -> perihilar "bat-wing" opacity + cardiomegaly + pleural effusions.', }, ], }, { 'id':'BRONCHIECTASIS', 'color':TEAL, 'icon':'🌳', 'harrisons': 'Harrison\'s 22E, Ch.301 (Baron et al.)', 'definition': 'Bronchiectasis is irreversible dilation of the bronchi resulting from chronic inflammation and infection. Harrison\'s notes that CXR has limited sensitivity; HRCT is the gold standard. CXR shows tram-track signs, ring shadows, and increased bronchovascular markings.', 'images': [ { 'file':'images/ann_bronchi_01.jpg', 'finding':'TRAM-TRACK SIGN + RING SHADOWS', 'subtitle':'Dilated Bronchi - Cylindrical Bronchiectasis', 'tag':'BRONCHIECTASIS - CHRONIC', 'tag_color':TEAL, 'status':'CHRONIC', 'bullets':[ 'TRAM-TRACK SIGN: parallel lines (dilated bronchial walls) visible on CXR', 'RING SHADOWS: circular opacities (end-on view of dilated bronchi)', 'Increased bronchial wall markings / peribronchial thickening', 'Mucous plugging: Y or V shaped opacities (tree-in-bud on CT)', 'Lower lobe predominant (gravity-dependent secretion pooling)', 'HRCT: "signet ring sign" - bronchus wider than accompanying artery', ], 'tip':'CXR has LOW sensitivity for bronchiectasis - it may look normal! HRCT (1-3 mm slices) is gold standard. Signet ring sign on CT = bronchus > artery in diameter.', 'ref':'Harrison\'s 22E, Ch.301 - CXR is insensitive for bronchiectasis; HRCT shows cylindrical, varicose, or cystic patterns with signet ring sign.', }, ], }, ] # ══════════════════════════════════════════════════════════════════════════════ # PAGE CALLBACKS # ══════════════════════════════════════════════════════════════════════════════ total_img_pages = sum(len(d['images']) for d in diseases) def on_page(c, doc): pg = doc.page; c.saveState() if pg == 1: c.setFillColor(DARK); c.rect(0,0,W,H,fill=1,stroke=0) for i in range(8): c.setFillColorRGB(0.08,0.4,0.76, 0.04+i*0.01) c.rect(0,H*(0.1*i),W,H*0.12,fill=1,stroke=0) c.setFillColor(BLUE_L); c.rect(0,H-6,W,6,fill=1,stroke=0) c.setFillColor(ACCENT); c.rect(0,H-12,W,6,fill=1,stroke=0) c.setFillColor(DARK); c.rect(0,0,W,28,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(WHITE) c.drawCentredString(W/2,10,'Respiratory Pathology X-Ray Teaching Guide | Based on Harrison\'s Principles of Internal Medicine 22E | For Educational Use Only') elif pg == doc.page and pg > 1: c.setFillColor(colors.HexColor('#FAFAFA')); c.rect(0,0,W,H,fill=1,stroke=0) c.setFillColor(DARK); c.rect(0,H-34,W,34,fill=1,stroke=0) c.setFont('Helvetica-Bold',8); c.setFillColor(WHITE) c.drawString(12,H-22,"RESPIRATORY PATHOLOGY | CHEST X-RAY TEACHING SERIES | Harrison's 22E") c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawRightString(W-12,H-22,'For Educational Use Only') c.setFillColor(DARK); c.rect(0,0,W,22,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawCentredString(W/2,7,f'Page {pg}') c.restoreState() doc = SimpleDocTemplate(OUTPUT, pagesize=A4, topMargin=46, bottomMargin=30, leftMargin=26, rightMargin=26, title='Respiratory Pathology X-Ray Teaching Guide', author='Orris Medical Education / Harrison\'s 22E') story = [] # ─── COVER ──────────────────────────────────────────────────────────────────── story.append(Spacer(1,2*cm)) story.append(Paragraph("HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 22E", S('',fontName='Helvetica-Bold',fontSize=10,textColor=YELL,alignment=TA_CENTER,spaceAfter=4))) story.append(Spacer(1,0.15*cm)) story.append(Paragraph('RESPIRATORY PATHOLOGY', S('',fontName='Helvetica-Bold',fontSize=28,textColor=WHITE,alignment=TA_CENTER,spaceAfter=6,leading=34))) story.append(Paragraph('Complete Chest X-Ray Findings', S('',fontName='Helvetica-Bold',fontSize=17,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER,spaceAfter=4))) story.append(Spacer(1,0.2*cm)) story.append(HRFlowable(width='80%',thickness=2,color=ACCENT,spaceAfter=8,spaceBefore=4)) story.append(Paragraph('One Finding | One X-Ray | All Major Respiratory Diseases', S('',fontName='Helvetica-Oblique',fontSize=11,textColor=colors.HexColor('#B0BEC5'),alignment=TA_CENTER,spaceAfter=4))) story.append(Spacer(1,0.3*cm)) # Disease list on cover cover_dis = [ [Paragraph('<b>#</b>',S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE,alignment=TA_CENTER)), Paragraph('<b>Disease</b>',S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE,alignment=TA_CENTER)), Paragraph('<b>Images</b>',S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE,alignment=TA_CENTER))] ] for i,d in enumerate(diseases,1): n = len(d['images']) cover_dis.append([ Paragraph(str(i),S('',fontName='Helvetica-Bold',fontSize=9,textColor=YELL,alignment=TA_CENTER)), Paragraph(f'{d["icon"]} <b>{d["id"]}</b>',S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE)), Paragraph(f'{n} X-ray{"s" if n>1 else ""}',S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER)), ]) ct = Table(cover_dis, colWidths=[1*cm,12*cm,3.5*cm]) ct.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0),BLUE), ('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.HexColor('#0D2137'),colors.HexColor('#0A1628')]), ('GRID',(0,0),(-1,-1),0.5,colors.HexColor('#1E3A5F')), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4), ('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ])) story.append(ct) story.append(Spacer(1,0.8*cm)) story.append(Paragraph(f'Total: {sum(len(d["images"]) for d in diseases)} annotated X-ray cases across 10 respiratory diseases', S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#607D8B'),alignment=TA_CENTER))) story.append(PageBreak()) # ─── DISEASE PAGES ──────────────────────────────────────────────────────────── for d in diseases: color = d['color'] # Disease banner page story.append(Spacer(1,0.2*cm)) # Big banner banner = Table([[ Paragraph(f'{d["icon"]} <b>{d["id"]}</b>', S('',fontName='Helvetica-Bold',fontSize=18,textColor=WHITE,leading=22)), Paragraph(f'<b>{d["harrisons"]}</b>', S('',fontName='Helvetica-Bold',fontSize=8,textColor=YELL,alignment=TA_CENTER)), ]], colWidths=[12*cm,4.5*cm]) banner.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),color), ('TOPPADDING',(0,0),(-1,-1),8),('BOTTOMPADDING',(0,0),(-1,-1),8), ('LEFTPADDING',(0,0),(0,0),10),('RIGHTPADDING',(0,0),(-1,-1),8), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ])) story.append(banner) story.append(Spacer(1,4)) # Definition box def_box = Table([[Paragraph(f'<b>DEFINITION (Harrison\'s 22E):</b> {d["definition"]}', S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#212121'),leading=13))]], colWidths=[16.5*cm]) def_box.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),L_BLUE), ('BOX',(0,0),(-1,-1),1.5,color), ('TOPPADDING',(0,0),(-1,-1),7),('BOTTOMPADDING',(0,0),(-1,-1),7), ('LEFTPADDING',(0,0),(-1,-1),10),('RIGHTPADDING',(0,0),(-1,-1),10), ])) story.append(def_box) story.append(Spacer(1,6)) # Each image = one finding for img in d['images']: # Finding header fhdr = Table([[ Paragraph(f'<b>{img["finding"]}</b><br/><font size="9" color="#90CAF9">{img["subtitle"]}</font>', S('',fontName='Helvetica-Bold',fontSize=13,textColor=WHITE,leading=17)), Paragraph(f'<b>{img["status"]}</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=WHITE,alignment=TA_CENTER)), ]], colWidths=[13*cm,3.5*cm]) fhdr.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),DARK), ('BACKGROUND',(1,0),(1,0),img['tag_color']), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6), ('LEFTPADDING',(0,0),(0,0),8), ])) story.append(fhdr) story.append(Spacer(1,2)) # Tag tag_t = Table([[Paragraph(f'<b>{img["tag"]}</b>', S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE,alignment=TA_CENTER))]], colWidths=[16.5*cm]) tag_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),img['tag_color']), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ])) story.append(tag_t) story.append(Spacer(1,4)) # Image pil = PILImage.open(img['file']) iw,ih = pil.size max_w,max_h = 16.5*cm, 10*cm scale = min(max_w/iw, max_h/ih) ri = RLImage(img['file'], width=iw*scale, height=ih*scale) ri.hAlign = 'CENTER' img_t = Table([[ri]], colWidths=[16.5*cm]) img_t.setStyle(TableStyle([ ('ALIGN',(0,0),(-1,-1),'CENTER'), ('BOX',(0,0),(-1,-1),2,color), ('BACKGROUND',(0,0),(-1,-1),colors.black), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ])) story.append(img_t) story.append(Spacer(1,2)) story.append(Paragraph( '<i>Annotation key: Red = Main Finding | Orange = Secondary | Blue = Fluid/Air | Green = Chronic | Yellow = Key Arrow/Point</i>', S('',fontName='Helvetica-Oblique',fontSize=7,textColor=colors.HexColor('#546E7A'),alignment=TA_CENTER,spaceAfter=2))) story.append(Spacer(1,4)) # Two col: description + bullets desc_items = [Paragraph('<b>DESCRIPTION</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=BLUE,spaceAfter=3))] desc_items.append(Paragraph(f'<b>Reference:</b> {img["ref"]}',S('',fontName='Helvetica-Oblique',fontSize=8,textColor=colors.HexColor('#546E7A'),leading=11,spaceAfter=3))) look_items = [Paragraph('<b>WHAT TO LOOK FOR</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=RED,spaceAfter=3))] for b in img['bullets']: look_items.append(Paragraph(f'- {b}', bul)) def box_wrap(items, bg, w): inner = Table([[p] for p in items], colWidths=[w]) inner.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),bg), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),3), ('LEFTPADDING',(0,0),(-1,-1),7),('RIGHTPADDING',(0,0),(-1,-1),7), ])) return inner two = Table([[box_wrap(desc_items,L_BLUE,7.6*cm), box_wrap(look_items,L_ORNG,7.6*cm)]], colWidths=[8.0*cm,8.5*cm]) two.setStyle(TableStyle([ ('VALIGN',(0,0),(-1,-1),'TOP'), ('LEFTPADDING',(0,0),(-1,-1),0),('RIGHTPADDING',(0,0),(-1,-1),0), ('TOPPADDING',(0,0),(-1,-1),0),('BOTTOMPADDING',(0,0),(-1,-1),0), ('LEFTPADDING',(1,0),(1,0),4), ])) story.append(two) story.append(Spacer(1,4)) # Tip tip_t = Table([[Paragraph(f'<b>CLINICAL TIP:</b> {img["tip"]}', S('',fontName='Helvetica',fontSize=9.5,textColor=colors.HexColor('#BF360C'),leading=13))]], colWidths=[16.5*cm]) tip_t.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),L_YELL), ('BOX',(0,0),(-1,-1),1.5,ACCENT), ('LEFTPADDING',(0,0),(-1,-1),10),('RIGHTPADDING',(0,0),(-1,-1),10), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5), ])) story.append(tip_t) story.append(Spacer(1,6)) story.append(PageBreak()) # ─── FINAL SUMMARY TABLE ────────────────────────────────────────────────────── story.append(Spacer(1,0.4*cm)) story.append(Paragraph("MASTER SUMMARY TABLE", S('',fontName='Helvetica-Bold',fontSize=18,textColor=WHITE,alignment=TA_CENTER,spaceAfter=4))) story.append(Paragraph("All 10 Respiratory Diseases - X-Ray Findings at a Glance (Harrison's 22E)", S('',fontName='Helvetica',fontSize=10,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER,spaceAfter=6))) story.append(Spacer(1,0.3*cm)) sum_rows = [ [Paragraph('<b>Disease</b>',tblH), Paragraph('<b>Key CXR Sign</b>',tblH), Paragraph('<b>Status</b>',tblH), Paragraph('<b>Pitfall / Pearl</b>',tblH)] ] sum_data = [ ('Pneumonia','Lobar consolidation + air bronchogram','Active','Air bronchogram = alveolar process'), ('COPD/Emphysema','Hyperinflation + flat diaphragms','Chronic','CXR normal in mild COPD; CT better'), ('Asthma','Hyperinflation (ONLY during attack)','Acute Attack','Stable asthma = normal CXR always'), ('Pleural Effusion','Meniscus sign + blunted CP angle','Active','Shift AWAY = effusion; shift TOWARD = collapse'), ('Pneumothorax','Visceral pleural line + absent markings','Urgent','Tension PTX = clinical diagnosis, treat first!'), ('Lung Cancer','Spiculated nodule OR hilar mass','Malignancy','Any new hilar mass in smoker = cancer till proven otherwise'), ('Tuberculosis','Apical infiltrate + thick-walled cavity','Active','Look at apex FIRST; thick wall = active disease'), ('Pulmonary Embolism','Westermark sign + Hampton hump','Urgent','NORMAL CXR never rules out PE!'), ('Pulmonary Edema','Bat-wing perihilar opacity + CTR>0.5','Emergency','ARDS: bilateral edema WITHOUT cardiomegaly'), ('Bronchiectasis','Tram-track + ring shadows','Chronic','HRCT gold standard; CXR often normal/subtle'), ] for row in sum_data: sum_rows.append([Paragraph(row[0],S('',fontName='Helvetica-Bold',fontSize=8.5,textColor=colors.HexColor('#212121'),alignment=TA_CENTER)), Paragraph(row[1],S('',fontName='Helvetica',fontSize=8.5,textColor=colors.HexColor('#212121'),alignment=TA_CENTER)), Paragraph(row[2],S('',fontName='Helvetica-Bold',fontSize=8,textColor=RED,alignment=TA_CENTER)), Paragraph(row[3],S('',fontName='Helvetica-Oblique',fontSize=8,textColor=colors.HexColor('#37474F')))]) st = Table(sum_rows, colWidths=[3.5*cm,4.5*cm,2.5*cm,6*cm], repeatRows=1) st.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0),DARK), ('TEXTCOLOR',(0,0),(-1,0),WHITE), ('ROWBACKGROUNDS',(0,1),(-1,-1),[L_BLUE,WHITE]), ('GRID',(0,0),(-1,-1),0.5,colors.HexColor('#B0BEC5')), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5), ('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ])) story.append(st) story.append(Spacer(1,0.5*cm)) # Golden rules rules = [ '1. PNEUMONIA: New opacity + fever + cough = pneumonia. Air bronchogram = alveolar disease.', '2. COPD: Hyperinflation + flat diaphragm + vascular pruning. CXR may be normal early.', '3. ASTHMA: NORMAL CXR in stable asthma. Order CXR only to exclude complications.', '4. PLEURAL EFFUSION: Meniscus + blunted angle. Shift away = effusion. Shift toward = collapse.', '5. PNEUMOTHORAX: Visceral pleural line. Tension PTX = clinical emergency - treat before CXR!', '6. LUNG CANCER: Spiculated nodule = malignant until proven. Central hilar mass in smoker = urgent.', '7. TB: Apex first! Thick wall = active. Miliary = bilateral 1-3mm = emergency. Thin wall = old.', '8. PULMONARY EMBOLISM: Normal CXR NEVER rules out PE. Westermark + Hampton hump are rare.', '9. PULMONARY EDEMA: Bat-wing + CTR>0.5 + Kerley B lines = cardiogenic. Rapid change with treatment.', '10. BRONCHIECTASIS: Tram-track + ring shadows on CXR. Signet ring on HRCT is gold standard.', ] rules_rows = [[Paragraph("<b>THE GOLDEN RULES - RESPIRATORY X-RAY (Harrison's 22E)</b>", S('',fontName='Helvetica-Bold',fontSize=11,textColor=YELL,spaceAfter=5))]] for r in rules: rules_rows.append([Paragraph(r, S('',fontName='Helvetica',fontSize=9.5,textColor=WHITE,leading=14))]) rt = Table(rules_rows, colWidths=[16.5*cm]) rt.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),DARK), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ('LEFTPADDING',(0,0),(-1,-1),14),('RIGHTPADDING',(0,0),(-1,-1),14), ('TOPPADDING',(0,0),(0,0),10),('BOTTOMPADDING',(-1,-1),(-1,-1),10), ])) story.append(rt) doc.build(story, onFirstPage=on_page, onLaterPages=on_page) sz = os.path.getsize(OUTPUT) print(f'PDF created: {OUTPUT} ({sz//1024} KB)') PYEOF

normal ECG sinus rhythm 12 lead electrocardiogram

atrial fibrillation ECG irregular rhythm no P waves

ST elevation myocardial infarction STEMI ECG

left bundle branch block LBBB ECG broad QRS

complete heart block third degree AV block ECG

ventricular tachycardia VT ECG wide complex tachycardia

atrial flutter sawtooth pattern ECG

Wolff Parkinson White WPW delta wave ECG preexcitation

hyperkalemia peaked T waves ECG electrolyte

right bundle branch block RBBB rSR prime V1 ECG

mkdir -p /tmp/workspace/ecg-pdf/images && python3 << 'PYEOF' import urllib.request, os H = {'User-Agent': 'Mozilla/5.0'} imgs = [ # Normal ECG ('normal_ecg.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_2151fc2dd8926ec5c88bfa0d9417d5ed22acfcd4b0ec972f51a72077d4c8e486.jpg'), # AF ('af_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_333b84c1869147154747f5916492705fa2c41fdebf5af80311f90637c65ab670.jpg'), ('af_02_coarse.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_392b76999223cda897fa41eac89e19c4f87e1780d849027cd1e996ba7b.jpg'), # STEMI ('stemi_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_16738d4b125195130b5e53a811645d4064182fc2bbd0de16b0e00a57af7ff6ef.jpg'), # LBBB ('lbbb_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0be77a66b30cb075621a21dd8998f7155ef974dd06a6228a0372c6857541db8d.jpg'), # RBBB ('rbbb_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_62e9e98ba5f94aab23a10bc23851468c16ba9883a6c9109b463fc5a1ab797e28.jpg'), # Heart Block (3 types on one image) ('heartblock_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_371aeb8e49e2595a2911c1b225b74f8fc59435744fe07138b6de279dfe692696.jpg'), ('heartblock_02.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_11ac037ff7836678ddd7fad143600ed71c2a3910d226a34ea257a3618beab0a5.jpg'), # VT ('vt_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_4d2179f789ce3524f9485f794bee84cfb9c8903680a47f3c0ab8e983da241d84.jpg'), # Atrial Flutter ('aflutter_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6972c99c41198141c1152608ad60c7df06a118ed4473be990a93ccce8134e864.jpg'), ('aflutter_02.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6a856fdaf3eb67189da5ecd9d26daac349352488ca84359add5e70a2a8d6bbff.jpg'), # WPW ('wpw_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_57a457581081cf127e4bce2cf0dff4f373983b861931a30669136410edcd6327.jpg'), # Hyperkalemia ('hyperk_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_0e4bd03ffc3858d2de708753614934bc362a034d58a5c5794a71656f8a47c44b.jpg'), # Junctional tachycardia (also shows normal vs junctional comparison) ('junctional_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_17c9cbbfc656b3046696570fd4b151f959c895f498adcebe5ebecf4af15cbbe6.jpg'), # Torsades / QT prolongation ('torsades_01.jpg', 'https://cdn.orris.care/cdss_images/pmc_clinical_VQA_6c323e8f5453670c5e2be001a8d1ebf41666fb138b01d3d6dc2aaeb6c4f16329.jpg'), ] for fname, url in imgs: try: req = urllib.request.Request(url, headers=H) with urllib.request.urlopen(req, timeout=20) as r: data = r.read() with open(f'/tmp/workspace/ecg-pdf/images/{fname}', 'wb') as f: f.write(data) print(f'OK {fname} ({len(data)//1024}KB)') except Exception as e: print(f'FAIL {fname}: {e}') PYEOF

cd /tmp/workspace/ecg-pdf && python3 << 'PYEOF' from PIL import Image, ImageDraw, ImageFont import math, os def get_font(size): for p in ['/usr/share/fonts/truetype/dejavu/DejaVuSans-Bold.ttf', '/usr/share/fonts/truetype/liberation/LiberationSans-Bold.ttf']: try: return ImageFont.truetype(p, max(10, int(size))) except: pass return ImageFont.load_default() def lbg(draw, text, x, y, font, tc=(255,255,255), bg=(0,0,0,200)): bb = draw.textbbox((x,y), text, font=font) draw.rectangle([bb[0]-3,bb[1]-2,bb[2]+3,bb[3]+2], fill=bg) draw.text((x,y), text, fill=tc, font=font) def arrow(draw, x1,y1,x2,y2, col, w=3): draw.line([(x1,y1),(x2,y2)], fill=col, width=w) a = math.atan2(y2-y1,x2-x1); al=16 for da in [-0.4,0.4]: draw.line([(x2,y2),(x2-al*math.cos(a-da),y2-al*math.sin(a-da))],fill=col,width=w) def annotate(src, dst, anns): img = Image.open(src).convert('RGB') W,H = img.size lw = max(2, int(min(W,H)*0.004)) fn = get_font(H*0.030) fn_sm = get_font(H*0.024) for a in anns: c = a['color']; lbl = a.get('label','') ov = Image.new('RGBA', img.size, (0,0,0,0)) od = ImageDraw.Draw(ov) t = a['type'] if t == 'rect': x,y,w,h = int(a['x']*W),int(a['y']*H),int(a['w']*W),int(a['h']*H) od.rectangle([x,y,x+w,y+h], outline=c+(255,), width=lw, fill=c+(50,)) img = Image.alpha_composite(img.convert('RGBA'), ov).convert('RGB') d2 = ImageDraw.Draw(img,'RGBA') lbg(d2, lbl, x+4, y+4, fn_sm) elif t == 'circle': cx,cy,r = int(a['x']*W),int(a['y']*H),int(a['r']*min(W,H)) od.ellipse([cx-r,cy-r,cx+r,cy+r], outline=c+(255,), width=lw, fill=c+(45,)) img = Image.alpha_composite(img.convert('RGBA'), ov).convert('RGB') d2 = ImageDraw.Draw(img,'RGBA') lbg(d2, lbl, cx-r, cy-r-int(fn_sm.size*1.5), fn_sm) elif t == 'arrow': x1,y1,x2,y2 = int(a['x1']*W),int(a['y1']*H),int(a['x2']*W),int(a['y2']*H) d2 = ImageDraw.Draw(img,'RGBA') arrow(d2,x1,y1,x2,y2,c+(255,),lw+1) lbg(d2, lbl, x1, y1-int(fn_sm.size*1.5), fn_sm) elif t == 'hline': y = int(a['y']*H); x1 = int(a.get('x1',0.0)*W); x2 = int(a.get('x2',1.0)*W) d2 = ImageDraw.Draw(img,'RGBA') d2.line([(x1,y),(x2,y)], fill=c+(255,), width=lw+1) lbg(d2, lbl, x1+4, y-int(fn_sm.size*1.5)-2, fn_sm) img.save(dst, quality=92) print(f' {dst}') tasks = [ # NORMAL ECG - label key components ('images/normal_ecg.jpg','images/ann_normal.jpg',[ {'type':'arrow','x1':0.13,'y1':0.30,'x2':0.17,'y2':0.45,'color':(0,220,255),'label':'P wave'}, {'type':'arrow','x1':0.25,'y1':0.20,'x2':0.23,'y2':0.35,'color':(255,80,80),'label':'QRS complex'}, {'type':'arrow','x1':0.32,'y1':0.20,'x2':0.28,'y2':0.42,'color':(0,255,120),'label':'T wave'}, {'type':'rect','x':0.12,'y':0.38,'w':0.10,'h':0.22,'color':(255,220,0),'label':'PR interval'}, {'type':'rect','x':0.21,'y':0.35,'w':0.06,'h':0.28,'color':(255,80,80),'label':'QRS'}, {'type':'rect','x':0.26,'y':0.38,'w':0.07,'h':0.18,'color':(0,200,80),'label':'ST segment'}, ]), # AF - fibrillatory baseline, irregular RR ('images/af_01.jpg','images/ann_af.jpg',[ {'type':'rect','x':0.05,'y':0.83,'w':0.88,'h':0.12,'color':(255,80,80),'label':'Irregularly Irregular RR intervals'}, {'type':'rect','x':0.05,'y':0.83,'w':0.40,'h':0.10,'color':(255,220,0),'label':'No P waves - Fibrillatory (f) waves'}, {'type':'arrow','x1':0.30,'y1':0.75,'x2':0.20,'y2':0.87,'color':(255,220,0),'label':'f waves (fine baseline oscillation)'}, {'type':'arrow','x1':0.70,'y1':0.72,'x2':0.65,'y2':0.83,'color':(0,220,255),'label':'Variable RR interval'}, ]), # STEMI ('images/stemi_01.jpg','images/ann_stemi.jpg',[ {'type':'rect','x':0.50,'y':0.05,'w':0.22,'h':0.88,'color':(255,80,80),'label':'ST Elevation V1-V3 (Anterior STEMI)'}, {'type':'rect','x':0.72,'y':0.05,'w':0.12,'h':0.88,'color':(255,80,80),'label':'ST Elev V4'}, {'type':'arrow','x1':0.62,'y1':0.15,'x2':0.58,'y2':0.30,'color':(255,220,0),'label':'Convex ST elevation'}, {'type':'arrow','x1':0.82,'y1':0.82,'x2':0.76,'y2':0.68,'color':(0,220,255),'label':'Reciprocal ST depression'}, {'type':'rect','x':0.50,'y':0.40,'w':0.10,'h':0.20,'color':(255,165,0),'label':'Hyperacute T waves'}, ]), # LBBB ('images/lbbb_01.jpg','images/ann_lbbb.jpg',[ {'type':'rect','x':0.05,'y':0.05,'w':0.88,'h':0.90,'color':(255,80,80),'label':'Wide QRS > 120ms (LBBB)'}, {'type':'rect','x':0.05,'y':0.05,'w':0.28,'h':0.42,'color':(255,165,0),'label':'Broad notched R (Lead I/aVL/V5-V6)'}, {'type':'rect','x':0.55,'y':0.05,'w':0.12,'h':0.30,'color':(0,220,255),'label':'Deep S wave V1 (rS pattern)'}, {'type':'arrow','x1':0.50,'y1':0.80,'x2':0.40,'y2':0.70,'color':(255,220,0),'label':'Discordant T waves (secondary change)'}, ]), # RBBB ('images/rbbb_01.jpg','images/ann_rbbb.jpg',[ {'type':'rect','x':0.55,'y':0.05,'w':0.14,'h':0.35,'color':(255,80,80),'label':"rSR' (M-shape) in V1"}, {'type':'arrow','x1':0.60,'y1':0.25,'x2':0.62,'y2':0.15,'color':(255,220,0),"label":"R' (Rabbit ear) in V1"}, {'type':'rect','x':0.05,'y':0.05,'w':0.28,'h':0.40,'color':(0,220,255),'label':'Slurred S wave in I, aVL, V5-V6'}, {'type':'rect','x':0.05,'y':0.05,'w':0.88,'h':0.88,'color':(255,165,0),'label':'Wide QRS > 120ms (RBBB)'}, ]), # Heart Block comparison ('images/heartblock_01.jpg','images/ann_heartblock.jpg',[ {'type':'rect','x':0.02,'y':0.02,'w':0.96,'h':0.28,'color':(0,220,255),'label':'1st Degree: Prolonged PR interval (>200ms)'}, {'type':'rect','x':0.02,'y':0.35,'w':0.96,'h':0.28,'color':(255,165,0),'label':'Complete Heart Block: P waves dissociated from QRS'}, {'type':'rect','x':0.02,'y':0.68,'w':0.96,'h':0.28,'color':(255,80,80),'label':'Ventricular Asystole: P waves but NO QRS'}, {'type':'arrow','x1':0.85,'y1':0.45,'x2':0.75,'y2':0.50,'color':(255,220,0),'label':'Slow escape rhythm'}, ]), # VT ('images/vt_01.jpg','images/ann_vt.jpg',[ {'type':'rect','x':0.05,'y':0.05,'w':0.88,'h':0.88,'color':(255,80,80),'label':'Wide complex tachycardia (VT) - QRS >120ms'}, {'type':'arrow','x1':0.20,'y1':0.20,'x2':0.15,'y2':0.40,'color':(255,220,0),'label':'First VT beat'}, {'type':'arrow','x1':0.55,'y1':0.15,'x2':0.50,'y2':0.30,'color':(0,220,255),'label':'Regular wide QRS (monomorphic VT)'}, {'type':'rect','x':0.05,'y':0.60,'w':0.40,'h':0.25,'color':(255,165,0),'label':'AV dissociation (P waves independent)'}, ]), # Atrial flutter ('images/aflutter_01.jpg','images/ann_aflutter.jpg',[ {'type':'rect','x':0.05,'y':0.40,'w':0.88,'h':0.30,'color':(255,220,0),'label':'Sawtooth flutter waves (F waves) - INFERIOR leads'}, {'type':'rect','x':0.05,'y':0.70,'w':0.88,'h':0.25,'color':(255,80,80),'label':'Atrial rate ~300bpm, Variable AV block'}, {'type':'arrow','x1':0.25,'y1':0.35,'x2':0.20,'y2':0.48,'color':(0,220,255),'label':'F wave (flutter wave)'}, {'type':'arrow','x1':0.50,'y1':0.30,'x2':0.48,'y2':0.45,'color':(255,165,0),'label':'Variable RR (variable block)'}, ]), # WPW ('images/wpw_01.jpg','images/ann_wpw.jpg',[ {'type':'rect','x':0.05,'y':0.05,'w':0.88,'h':0.88,'color':(255,80,80),'label':'Short PR interval (<120ms) + Delta wave'}, {'type':'arrow','x1':0.18,'y1':0.20,'x2':0.22,'y2':0.45,'color':(255,220,0),'label':'Delta wave (slurred QRS onset)'}, {'type':'rect','x':0.55,'y':0.05,'w':0.14,'h':0.35,'color':(0,220,255),'label':'Dominant R in V1 (Left AP)'}, {'type':'rect','x':0.05,'y':0.42,'w':0.28,'h':0.30,'color':(255,165,0),'label':'Negative delta in inferior leads (pseudoinfarction)'}, ]), # Hyperkalemia ('images/hyperk_01.jpg','images/ann_hyperk.jpg',[ {'type':'rect','x':0.30,'y':0.05,'w':0.55,'h':0.88,'color':(255,80,80),'label':'Tall PEAKED T waves (tenting) - V2-V5'}, {'type':'rect','x':0.05,'y':0.05,'w':0.28,'h':0.88,'color':(255,165,0),'label':'Wide QRS (conduction delay)'}, {'type':'arrow','x1':0.88,'y1':0.30,'x2':0.80,'y2':0.45,'color':(255,220,0),'label':'Narrow-based tall T wave'}, {'type':'rect','x':0.05,'y':0.45,'w':0.25,'h':0.25,'color':(0,220,255),'label':'Flattened/absent P waves'}, ]), # QT prolongation + Torsades ('images/torsades_01.jpg','images/ann_torsades.jpg',[ {'type':'rect','x':0.02,'y':0.62,'w':0.96,'h':0.32,'color':(255,80,80),'label':'Torsades de Pointes: Twisting QRS axis'}, {'type':'rect','x':0.02,'y':0.02,'w':0.96,'h':0.28,'color':(0,220,255),'label':'Normal QTc 440ms (Pre-op)'}, {'type':'rect','x':0.02,'y':0.34,'w':0.96,'h':0.24,'color':(255,165,0),'label':'Short-Long-Short initiating TdP'}, {'type':'arrow','x1':0.50,'y1':0.72,'x2':0.60,'y2':0.80,'color':(255,220,0),'label':'Rotating QRS axis (twisting of points)'}, ]), # Junctional tachycardia vs normal ('images/junctional_01.jpg','images/ann_junctional.jpg',[ {'type':'rect','x':0.02,'y':0.02,'w':0.96,'h':0.45,'color':(255,80,80),'label':'Junctional Tachycardia: Retrograde P waves AFTER QRS'}, {'type':'rect','x':0.02,'y':0.52,'w':0.96,'h':0.45,'color':(0,220,255),'label':'Normal Sinus Rhythm: Upright P BEFORE QRS'}, {'type':'arrow','x1':0.30,'y1':0.10,'x2':0.35,'y2':0.20,'color':(255,220,0),'label':'Retrograde (inverted) P wave'}, {'type':'arrow','x1':0.30,'y1':0.75,'x2':0.25,'y2':0.65,'color':(0,255,120),'label':'Normal upright P wave'}, ]), ] for src, dst, anns in tasks: try: annotate(src, dst, anns) except Exception as e: print(f'ERROR {src}: {e}') print('Done') PYEOF

cd /tmp/workspace/ecg-pdf && python3 << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib import colors from reportlab.lib.units import cm from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Image as RLImage, Table, TableStyle, PageBreak, HRFlowable) from reportlab.lib.styles import ParagraphStyle from reportlab.lib.enums import TA_CENTER, TA_LEFT from PIL import Image as PILImage import os OUTPUT = 'ECG_Teaching_Guide.pdf' W, H = A4 # Colours DARK = colors.HexColor('#0A1628') DARK2 = colors.HexColor('#0D2137') BLUE = colors.HexColor('#1565C0') BLUE_L = colors.HexColor('#1E88E5') ACCENT = colors.HexColor('#FF6B35') YELL = colors.HexColor('#FFD600') RED = colors.HexColor('#E53935') GREEN = colors.HexColor('#00C853') TEAL = colors.HexColor('#00695C') PURPLE = colors.HexColor('#6A1B9A') AMBER = colors.HexColor('#E65100') WHITE = colors.white L_BLUE = colors.HexColor('#E3F2FD') L_ORNG = colors.HexColor('#FFF3E0') L_YELL = colors.HexColor('#FFF8E1') L_RED = colors.HexColor('#FFEBEE') ECG_GREEN = colors.HexColor('#00C853') def S(n, **kw): return ParagraphStyle(n, **kw) body = S('b', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#212121'), leading=13, spaceAfter=2) bul = S('bl', fontName='Helvetica', fontSize=9.5, textColor=colors.HexColor('#212121'), leading=13, spaceAfter=2, leftIndent=8, firstLineIndent=-8) tH = S('th', fontName='Helvetica-Bold', fontSize=9, textColor=WHITE, alignment=TA_CENTER) tB = S('tb', fontName='Helvetica', fontSize=8.5, textColor=colors.HexColor('#212121')) # ─── PAGE CALLBACKS ────────────────────────────────────────────────────────── def on_page(c, doc): pg = doc.page; c.saveState() if pg == 1: c.setFillColor(DARK); c.rect(0,0,W,H,fill=1,stroke=0) for i in range(10): c.setFillColorRGB(0.0,0.5,0.2,0.03+i*0.008) c.rect(0,H*(0.1*i),W,H*0.12,fill=1,stroke=0) # ECG waveform decoration (decorative sine-like line) c.setStrokeColor(ECG_GREEN); c.setLineWidth(2) c.setStrokeColorRGB(0,0.78,0.32,0.3) p = c.beginPath() import math p.moveTo(0, H*0.52) for x in range(0, int(W)+1, 3): t = x/W*6*math.pi y = H*0.52 + 20*math.sin(t) p.lineTo(x,y) c.drawPath(p, stroke=1, fill=0) c.setFillColor(BLUE_L); c.rect(0,H-6,W,6,fill=1,stroke=0) c.setFillColor(ECG_GREEN); c.rect(0,H-12,W,6,fill=1,stroke=0) c.setFillColor(DARK); c.rect(0,0,W,28,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(WHITE) c.drawCentredString(W/2,10,"ECG Teaching Guide | Harrison's Principles of Internal Medicine 22E | For Educational Use Only") else: c.setFillColor(colors.HexColor('#FAFAFA')); c.rect(0,0,W,H,fill=1,stroke=0) c.setFillColor(DARK); c.rect(0,H-34,W,34,fill=1,stroke=0) c.setFont('Helvetica-Bold',8); c.setFillColor(WHITE) c.drawString(12,H-22,'ECG TEACHING GUIDE | COMMON ECG ABNORMALITIES') c.setFont('Helvetica',8); c.setFillColor(ECG_GREEN) c.drawRightString(W-12,H-22,'For Educational Use Only') c.setFillColor(DARK); c.rect(0,0,W,22,fill=1,stroke=0) c.setFont('Helvetica',8); c.setFillColor(colors.HexColor('#90CAF9')) c.drawCentredString(W/2,7,f'Page {pg}') c.restoreState() doc = SimpleDocTemplate(OUTPUT, pagesize=A4, topMargin=46, bottomMargin=30, leftMargin=26, rightMargin=26, title='ECG Teaching Guide - Common ECG Abnormalities', author="Orris Medical Education / Harrison's 22E") story = [] # ═══ COVER ═══════════════════════════════════════════════════════════════════ story.append(Spacer(1,2.0*cm)) story.append(Paragraph("HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 22E", S('',fontName='Helvetica-Bold',fontSize=10,textColor=YELL,alignment=TA_CENTER,spaceAfter=3))) story.append(Spacer(1,0.2*cm)) story.append(Paragraph('ECG TEACHING GUIDE', S('',fontName='Helvetica-Bold',fontSize=30,textColor=WHITE,alignment=TA_CENTER,spaceAfter=5,leading=36))) story.append(Paragraph('Normal ECG + All Common Abnormalities', S('',fontName='Helvetica-Bold',fontSize=16,textColor=colors.HexColor('#90CAF9'),alignment=TA_CENTER,spaceAfter=4))) story.append(HRFlowable(width='80%',thickness=2,color=ECG_GREEN,spaceAfter=8,spaceBefore=4)) story.append(Paragraph('One Finding | One ECG | Annotated & Explained', S('',fontName='Helvetica-Oblique',fontSize=11,textColor=colors.HexColor('#B0BEC5'),alignment=TA_CENTER))) story.append(Spacer(1,0.5*cm)) contents = [ ('1', '⚡ Normal ECG', '+ Parameters (PR, QRS, QT, ST, T)'), ('2', '🔴 ST Elevation MI (STEMI)', 'Anterior: ST elevation V1-V4'), ('3', '🔵 Atrial Fibrillation', 'Irregularly irregular, no P waves, f waves'), ('4', '🟡 Atrial Flutter', 'Sawtooth F waves, 300bpm atrial rate'), ('5', '🟠 LBBB', 'Wide QRS, broad R in I/V5-V6, rS in V1'), ('6', '🟢 RBBB', "Wide QRS, rSR' in V1, slurred S in I/V5-V6"), ('7', '🔴 Heart Block (1st/2nd/3rd)', 'PR prolonged / dropped beats / AV dissociation'), ('8', '⚠️ Ventricular Tachycardia', 'Wide complex regular tachycardia, AV dissociation'), ('9', '🔵 WPW Syndrome', 'Short PR, delta wave, wide QRS'), ('10','🟡 Hyperkalemia', 'Peaked T waves, wide QRS, absent P waves'), ('11','🟠 QT Prolongation + TdP', 'Long QT, Torsades de Pointes'), ('12','🟢 Junctional Tachycardia', 'Narrow complex, retrograde P waves after QRS'), ] cov_rows = [[Paragraph('#',tH), Paragraph('Condition',tH), Paragraph('Key ECG Finding',tH)]] for r in contents: cov_rows.append([ Paragraph(r[0], S('',fontName='Helvetica-Bold',fontSize=9,textColor=YELL,alignment=TA_CENTER)), Paragraph(r[1], S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE)), Paragraph(r[2], S('',fontName='Helvetica-Oblique',fontSize=8.5,textColor=colors.HexColor('#90CAF9'))), ]) ct = Table(cov_rows, colWidths=[0.8*cm,7*cm,8.7*cm]) ct.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0),BLUE), ('ROWBACKGROUNDS',(0,1),(-1,-1),[DARK2,DARK]), ('GRID',(0,0),(-1,-1),0.5,colors.HexColor('#1E3A5F')), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4), ('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ])) story.append(ct) story.append(PageBreak()) # ═══ PAGE 2: NORMAL ECG + PARAMETERS ════════════════════════════════════════ story.append(Spacer(1,0.1*cm)) # Header hdr = Table([[ Paragraph('⚡ NORMAL ECG + PARAMETERS', S('',fontName='Helvetica-Bold',fontSize=16,textColor=WHITE,leading=20)), Paragraph('BASELINE REFERENCE', S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE,alignment=TA_CENTER)), ]], colWidths=[13*cm,3.5*cm]) hdr.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),DARK), ('BACKGROUND',(1,0),(1,0),BLUE), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('TOPPADDING',(0,0),(-1,-1),8),('BOTTOMPADDING',(0,0),(-1,-1),8), ('LEFTPADDING',(0,0),(0,0),10), ])) story.append(hdr) story.append(Spacer(1,5)) # Annotated normal ECG image pil = PILImage.open('images/ann_normal.jpg'); iw,ih = pil.size sc = min(16.5*cm/iw, 9.5*cm/ih) ri = RLImage('images/ann_normal.jpg', width=iw*sc, height=ih*sc); ri.hAlign='CENTER' it = Table([[ri]], colWidths=[16.5*cm]) it.setStyle(TableStyle([ ('ALIGN',(0,0),(-1,-1),'CENTER'), ('BOX',(0,0),(-1,-1),2,ECG_GREEN), ('BACKGROUND',(0,0),(-1,-1),colors.HexColor('#1a1a1a')), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ])) story.append(it) story.append(Spacer(1,3)) story.append(Paragraph( '<i>Annotation key: Cyan = P wave | Red = QRS | Green = T wave | Yellow = PR interval | Orange = ST segment</i>', S('',fontName='Helvetica-Oblique',fontSize=7,textColor=colors.HexColor('#546E7A'),alignment=TA_CENTER))) story.append(Spacer(1,6)) # Parameters table params = [ [Paragraph('<b>Parameter</b>',tH), Paragraph('<b>Normal Value</b>',tH), Paragraph('<b>What it Represents</b>',tH), Paragraph('<b>Abnormal if...</b>',tH)], ['Heart Rate','60-100 bpm','Ventricular rate','<60 = Bradycardia | >100 = Tachycardia'], ['P wave','<120ms, <2.5mm','Atrial depolarization','Absent = AF | Tall = RAE | Wide = LAE'], ['PR interval','120-200ms','AV node conduction time','>200ms = 1st degree block | <120ms = WPW'], ['QRS duration','<120ms','Ventricular depolarization','>120ms = BBB or ventricular rhythm'], ['QT interval (QTc)','<440ms (men) <460ms (women)','Ventricular repolarization','>500ms = High risk Torsades de Pointes'], ['ST segment','Isoelectric (flat)','Plateau phase before repolarization','Elevation = STEMI/pericarditis | Depression = ischaemia'], ['T wave','Upright in I,II,V3-V6','Ventricular repolarization','Inverted = ischaemia | Peaked = hyperkalaemia'], ['U wave','Follows T wave (small)','Purkinje repolarization','Prominent = hypokalaemia'], ['Axis','Normal: -30 to +90 deg','Direction of ventricular depolarization','LAD = LBBB, inferior MI | RAD = RBBB, RVH'], ] pt = Table(params, colWidths=[3.0*cm,3.5*cm,5.0*cm,5.0*cm], repeatRows=1) pt.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0),DARK), ('ROWBACKGROUNDS',(0,1),(-1,-1),[L_BLUE,WHITE]), ('FONTNAME',(0,1),(-1,-1),'Helvetica'), ('FONTSIZE',(0,1),(-1,-1),8), ('GRID',(0,0),(-1,-1),0.5,colors.HexColor('#B0BEC5')), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4), ('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('TEXTCOLOR',(3,1),(3,-1),RED),('FONTNAME',(3,1),(3,-1),'Helvetica'), ])) story.append(pt) # ECG paper speed/calibration box cal = Table([[Paragraph( '<b>ECG CALIBRATION STANDARDS:</b> Paper speed = 25 mm/s | ' '1 small box = 0.04s (40ms) horizontal = 0.1mV vertical | ' '1 large box = 0.2s (200ms) horizontal = 0.5mV vertical | ' 'Standard = 10mm = 1mV | Rate formula = 300 / (# large boxes between R-R)', S('',fontName='Helvetica',fontSize=8.5,textColor=colors.HexColor('#212121'),leading=13))]], colWidths=[16.5*cm]) cal.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),colors.HexColor('#F3E5F5')), ('BOX',(0,0),(-1,-1),1.5,PURPLE), ('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6), ('LEFTPADDING',(0,0),(-1,-1),10),('RIGHTPADDING',(0,0),(-1,-1),10), ])) story.append(Spacer(1,5)) story.append(cal) story.append(PageBreak()) # ═══ ABNORMALITY PAGES ════════════════════════════════════════════════════════ abnormalities = [ { 'num':'02','img':'images/ann_stemi.jpg','color':RED, 'title':'ST ELEVATION MYOCARDIAL INFARCTION (STEMI)', 'subtitle':'Convex ST Elevation - Acute Coronary Artery Occlusion', 'tag':'CARDIAC EMERGENCY - Call Cath Lab Immediately', 'tag_color':colors.HexColor('#B71C1C'), 'status':'EMERGENCY', 'mechanism':'Total occlusion of a coronary artery causes transmural ischaemia. The injured myocardium generates a current of injury that elevates the ST segment in the leads facing the infarct zone.', 'bullets':[ 'ST elevation >= 2mm in 2+ contiguous chest leads (V1-V6)', 'ST elevation >= 1mm in 2+ contiguous limb leads', 'Convex (tombstone/coved) ST elevation - curves upward', 'Reciprocal ST DEPRESSION in mirror leads (e.g., inferior = aVL depression)', 'Hyperacute T waves (earliest sign, minutes after occlusion)', 'Q waves develop hours later (necrosis marker)', 'Anterior STEMI (V1-V4) = LAD occlusion', 'Inferior STEMI (II,III,aVF) = RCA or LCx occlusion', ], 'tip':"STEMI = door-to-balloon time < 90 mins. LBBB + chest pain = treat as STEMI (Sgarbossa criteria). Posterior STEMI: ST depression V1-V3 (look for ST elevation in V7-V9).", 'ref':"Harrison's 22E, Ch.265 - ST elevation >= 1-2mm in 2+ contiguous leads = STEMI. Reciprocal changes confirm diagnosis. Immediate reperfusion is life-saving.", }, { 'num':'03','img':'images/ann_af.jpg','color':BLUE_L, 'title':'ATRIAL FIBRILLATION (AF)', 'subtitle':'Irregularly Irregular - No P Waves - Fibrillatory Baseline', 'tag':'MOST COMMON SUSTAINED ARRHYTHMIA', 'tag_color':BLUE, 'status':'ARRHYTHMIA', 'mechanism':'Chaotic, disorganized electrical activity in the atria (300-600 depolarizations/min). The AV node filters irregularly, producing the classic "irregularly irregular" ventricular response.', 'bullets':[ 'ABSENT P waves - replaced by fine fibrillatory (f) waves', 'f waves most visible in V1 and inferior leads', 'IRREGULARLY IRREGULAR RR intervals (the hallmark)', 'Narrow QRS complexes (unless aberrant conduction/BBB)', 'Ventricular rate typically 100-160 bpm if uncontrolled', 'Coarse AF: large f waves (>1mm) - often valvular', 'Fine AF: small f waves - often non-valvular', 'CHA2DS2-VASc score determines anticoagulation need', ], 'tip':'AF = irregularly irregular = NO two RR intervals are equal. AF with rapid rate = rate control first (beta-blocker/CCB). ALL AF patients need CHA2DS2-VASc stroke risk assessment.', 'ref':"Harrison's 22E, Ch.240 - AF is diagnosed by absent P waves + irregularly irregular rhythm. Rate control target <110 bpm at rest. Anticoagulate if CHA2DS2-VASc >= 2 (men) or >= 3 (women).", }, { 'num':'04','img':'images/ann_aflutter.jpg','color':AMBER, 'title':'ATRIAL FLUTTER', 'subtitle':'Sawtooth F Waves ~300bpm - Regular Macro-Reentry', 'tag':'SUPRAVENTRICULAR TACHYCARDIA', 'tag_color':AMBER, 'status':'ARRHYTHMIA', 'mechanism':'Macro-reentrant circuit in the right atrium around the tricuspid annex. Atrial rate = 300bpm. AV node conducts at 2:1, 3:1, or 4:1 ratio producing ventricular rate of 150, 100, or 75 bpm.', 'bullets':[ 'Classic SAWTOOTH pattern in inferior leads (II, III, aVF)', 'Atrial (F wave) rate = 300 bpm (regular)', 'No isoelectric baseline between flutter waves', 'Most common: 2:1 block = ventricular rate ~150 bpm', 'Variable block = irregular ventricular response', 'F waves INVERTED in inferior leads (typical, counter-clockwise)', 'Distinguish from AF: flutter has regular organized atrial activity', ], 'tip':"If you see a regular tachycardia at 150 bpm - ALWAYS think atrial flutter with 2:1 block. Use adenosine to 'unmask' flutter waves by temporarily slowing AV conduction.", 'ref':"Harrison's 22E, Ch.240 - Atrial flutter: atrial rate 300 bpm, regular saw-tooth in inferior leads. Cardioversion or catheter ablation (95% cure rate) are preferred treatments.", }, { 'num':'05','img':'images/ann_lbbb.jpg','color':PURPLE, 'title':'LEFT BUNDLE BRANCH BLOCK (LBBB)', 'subtitle':'Wide QRS > 120ms - Broad Notched R - rS in V1', 'tag':'INTRAVENTRICULAR CONDUCTION DEFECT', 'tag_color':PURPLE, 'status':'CONDUCTION ABNORMALITY', 'mechanism':'Failure of conduction in the left bundle branch. Activation of the left ventricle depends on slow cell-to-cell conduction from the right ventricle, causing a wide, abnormal QRS complex.', 'bullets':[ 'QRS duration > 120ms (3 small boxes)', 'Broad NOTCHED R waves in I, aVL, V5, V6 (WILLIAM pattern)', 'Deep QS or rS pattern in V1, V2', 'No septal Q waves in lateral leads (I, aVL, V5, V6)', 'Discordant ST-T changes: T wave opposite to QRS main deflection', 'Left axis deviation common', 'NEW LBBB + chest pain = treat as STEMI equivalent!', ], 'tip':"LBBB memory trick: WILLIAM - WiLLiaM = in V1 (W-shaped) and V6 (M-shaped). NEW LBBB + chest pain = STEMI equivalent, activate Cath Lab! Old LBBB = obscures ischaemia interpretation.", 'ref':"Harrison's 22E, Ch.237 - LBBB: QRS > 120ms, broad monophasic R in lateral leads, QS in V1. New LBBB with ACS symptoms warrants urgent revascularization.", }, { 'num':'06','img':'images/ann_rbbb.jpg','color':TEAL, 'title':'RIGHT BUNDLE BRANCH BLOCK (RBBB)', 'subtitle':"rSR' (Rabbit Ears) in V1 - Slurred S in I/V5-V6", 'tag':'INTRAVENTRICULAR CONDUCTION DEFECT', 'tag_color':TEAL, 'status':'CONDUCTION ABNORMALITY', 'mechanism':'Failure of conduction in the right bundle branch. The right ventricle is activated late by slow cell-to-cell spread from the left, producing a secondary R wave (R\') in V1.', 'bullets':[ 'QRS duration > 120ms', "rSR' pattern (M-shape / 'rabbit ears') in V1, V2", "Wide, slurred S waves in lateral leads (I, aVL, V5, V6)", 'T wave inversions in V1, V2 (secondary change)', 'Axis may be normal or rightward', 'Common causes: PE, RVH, ASD, ischaemia, normal variant', 'RBBB alone (without hemiblock) = usually benign', ], 'tip':"RBBB memory trick: MaRRoW - in V1 (M-shaped) and V6 (W-shaped). Right BBB is often incidental. BUT: New RBBB + inferior ST elevation = suspect proximal RCA occlusion.", 'ref':"Harrison's 22E, Ch.237 - RBBB: rSR' in V1, slurred S in lateral leads. Isolated RBBB may be normal. Bifascicular block (RBBB + LAHB) may precede complete heart block.", }, { 'num':'07','img':'images/ann_heartblock.jpg','color':RED, 'title':'HEART BLOCK (1st / 2nd / 3rd Degree)', 'subtitle':'AV Conduction Delay to Complete AV Dissociation', 'tag':'AV CONDUCTION ABNORMALITY', 'tag_color':RED, 'status':'CONDUCTION ABNORMALITY', 'mechanism':'Progressive failure of AV node or His-Purkinje conduction. 1st degree: delayed conduction. 2nd degree: intermittent failure. 3rd degree: complete failure with independent escape rhythm.', 'bullets':[ '1st DEGREE: PR interval > 200ms (>1 large box). Every P conducts.', '2nd DEGREE Mobitz I (Wenckebach): PR progressively lengthens until QRS drops', '2nd DEGREE Mobitz II: Fixed PR, then sudden P with NO QRS (more dangerous)', '3rd DEGREE (COMPLETE): P waves and QRS are completely INDEPENDENT (dissociated)', '3rd Degree: Atrial rate 60-100, Ventricular rate 30-40 bpm (escape rhythm)', 'P waves march through at their own rate regardless of QRS', 'Complete block = PACEMAKER required urgently', ], 'tip':"3rd Degree Block = AV DISSOCIATION. If you see P waves and QRS complexes marching independently at different rates = Complete Heart Block. URGENT pacemaker. Treat with atropine/isoprenaline as bridge.", 'ref':"Harrison's 22E, Ch.241 - 1st degree: PR >200ms. Mobitz II and 3rd degree block require pacemaker implantation. Mobitz I is usually benign (AV nodal level).", }, { 'num':'08','img':'images/ann_vt.jpg','color':RED, 'title':'VENTRICULAR TACHYCARDIA (VT)', 'subtitle':'Wide Complex Regular Tachycardia - AV Dissociation', 'tag':'LIFE-THREATENING ARRHYTHMIA - EMERGENCY', 'tag_color':colors.HexColor('#B71C1C'), 'status':'EMERGENCY', 'mechanism':'Rapid, abnormal ventricular depolarization from an ectopic focus or re-entrant circuit within the ventricles. QRS is wide because ventricular conduction is abnormal.', 'bullets':[ 'Wide QRS tachycardia (QRS > 120ms) at rate > 100 bpm', 'Regular RR intervals (monomorphic VT)', 'AV DISSOCIATION: P waves march independently (diagnostic)', 'Fusion beats and capture beats (pathognomonic of VT)', 'Concordance: all precordial leads positive OR all negative', 'Northwest axis (extreme axis deviation)', 'Brugada criteria help distinguish VT from SVT with aberrancy', 'Haemodynamically unstable VT = IMMEDIATE DC cardioversion', ], 'tip':"ANY wide complex tachycardia = presume VT until proven otherwise! Never give verapamil to a wide complex tachycardia. Brugada 4-step rule: absence of RS in V1-V6 = VT. AV dissociation = VT.", 'ref':"Harrison's 22E, Ch.242 - VT: wide complex tachycardia with AV dissociation. Stable VT: amiodarone. Unstable VT: synchronized DC cardioversion. Pulseless VT: defibrillate.", }, { 'num':'09','img':'images/ann_wpw.jpg','color':AMBER, 'title':'WOLFF-PARKINSON-WHITE (WPW) SYNDROME', 'subtitle':'Short PR + Delta Wave + Wide QRS = Pre-Excitation', 'tag':'PRE-EXCITATION SYNDROME', 'tag_color':AMBER, 'status':'PRE-EXCITATION', 'mechanism':'An accessory pathway (Bundle of Kent) bypasses the AV node and pre-excites the ventricle before the normal impulse arrives through the AV node, creating a delta wave.', 'bullets':[ 'SHORT PR interval (< 120ms)', 'DELTA WAVE: slurred, slow rise at the beginning of QRS', 'Widened QRS (> 120ms) due to delta wave', 'Pseudo-STEMI: negative delta waves in inferior leads mimic Q waves', 'Left-sided AP: dominant R in V1, negative delta in inferior leads', 'Right-sided AP: negative delta in V1, dominant S in V1', 'Risk: AF in WPW can conduct rapidly down the accessory path = VF', ], 'tip':"WPW + AF = DANGEROUS. The accessory pathway conducts at 300+ bpm = VF risk. NEVER give AV nodal blockers (adenosine, beta-blockers, verapamil) in WPW+AF. Use procainamide or cardiovert.", 'ref':"Harrison's 22E, Ch.240 - WPW: short PR + delta wave. RF ablation is curative (>95%). Avoid AV nodal blockers in WPW+AF. Asymptomatic WPW: risk stratify with EP study.", }, { 'num':'10','img':'images/ann_hyperk.jpg','color':colors.HexColor('#00695C'), 'title':'HYPERKALEMIA', 'subtitle':'Peaked T Waves - Wide QRS - Absent P Waves', 'tag':'ELECTROLYTE EMERGENCY', 'tag_color':RED, 'status':'METABOLIC EMERGENCY', 'mechanism':'Elevated serum K+ reduces the resting membrane potential, slowing conduction throughout the heart. ECG changes progress in a predictable sequence with rising K+ levels.', 'bullets':[ 'K+ 5.5-6.5: PEAKED T waves (narrow-based, symmetric, tall)', 'K+ 6.5-7.0: PR prolongation, flat or absent P waves', 'K+ 7.0-8.0: Wide QRS (intraventricular block)', 'K+ >8.0: SINE WAVE pattern (QRS merges with T wave)', 'K+ >10: Ventricular fibrillation / asystole', 'Peaked T waves: distinguish from normal by narrow base + symmetric shape', ], 'tip':"TREATMENT sequence: C-BIG-K: Calcium gluconate (membrane stabilize) -> Bicarbonate -> Insulin + Glucose -> Kayexalate (bind) -> Kidney (dialysis). ECG changes = emergency, don't wait for lab result.", 'ref':"Harrison's 22E, Ch.52 - Hyperkalemia ECG progression: peaked T waves -> P wave loss -> wide QRS -> sine wave -> VF. Treat when K+ >6.0 or any ECG changes.", }, { 'num':'11','img':'images/ann_torsades.jpg','color':PURPLE, 'title':'QT PROLONGATION + TORSADES DE POINTES', 'subtitle':'Long QT -> Polymorphic VT with Twisting QRS Axis', 'tag':'LONG QT SYNDROME - RISK OF SUDDEN DEATH', 'tag_color':PURPLE, 'status':'EMERGENCY', 'mechanism':'Prolonged repolarization creates a vulnerable window for early afterdepolarizations, triggering Torsades de Pointes (TdP) - a polymorphic VT where the QRS axis rotates around the isoelectric line.', 'bullets':[ 'QTc > 500ms = HIGH RISK for TdP', 'Torsades: polymorphic VT where QRS complexes "twist" around baseline', 'Classic initiating sequence: SHORT-LONG-SHORT RR before TdP onset', 'TdP may be self-terminating or degenerate into VF', 'QT prolonged by: drugs (antiarrhythmics, antipsychotics, antibiotics), hypokalaemia, hypomagnesaemia, hypothyroidism', 'Congenital Long QT syndrome: inherited ion channel defect', 'U waves may merge with T waves (pseudo-T prolongation)', ], 'tip':"TREATMENT: IV Magnesium (2g over 5-10 min) - first-line for TdP. Increase heart rate (isoproterenol/pacing) shortens QT. AVOID QT-prolonging drugs. Check and correct K+ and Mg2+.", 'ref':"Harrison's 22E, Ch.242 - QTc >500ms = high risk. TdP diagnosis: polymorphic VT with twisting morphology. IV magnesium is first-line treatment.", }, { 'num':'12','img':'images/ann_junctional.jpg','color':TEAL, 'title':'JUNCTIONAL TACHYCARDIA', 'subtitle':'Narrow Complex - Retrograde P Waves After QRS', 'tag':'SUPRAVENTRICULAR TACHYCARDIA', 'tag_color':TEAL, 'status':'ARRHYTHMIA', 'mechanism':'The AV junction (AV node or Bundle of His) acts as the dominant pacemaker. It activates the ventricles normally (narrow QRS) but conducts retrogradely to the atria (inverted P waves after QRS).', 'bullets':[ 'Narrow QRS complex tachycardia (< 120ms)', 'Rate 60-130 bpm (junctional tachycardia) or > 150 (AVNRT)', 'RETROGRADE P waves: inverted in II, III, aVF AFTER QRS complex', 'P wave may be within QRS (hidden) or just after QRS', 'Short RP interval (RP < PR)', 'Compare with normal: upright P BEFORE QRS (sinus rhythm)', 'AVNRT: most common SVT - retrograde P in ST segment, pseudo-S in II', ], 'tip':"Retrograde P wave AFTER QRS = junctional origin. Compare lead II: normal sinus = upright P before QRS. AVNRT = 'pseudo-S' in inferior leads. Treat with vagal maneuvers, then adenosine.", 'ref':"Harrison's 22E, Ch.240 - Junctional rhythm: inverted P waves in II, III, aVF. AVNRT most common SVT. Adenosine (6-12mg IV) terminates most junctional tachycardias.", }, ] for ab in abnormalities: col = ab['color'] # Banner bn = Table([[ Paragraph(f'<b>{ab["title"]}</b><br/><font size="9" color="#90CAF9">{ab["subtitle"]}</font>', S('',fontName='Helvetica-Bold',fontSize=14,textColor=WHITE,leading=18)), Paragraph(f'<b>{ab["status"]}</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=WHITE,alignment=TA_CENTER)), ]], colWidths=[13*cm,3.5*cm]) bn.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),DARK), ('BACKGROUND',(1,0),(1,0),col), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('TOPPADDING',(0,0),(-1,-1),7),('BOTTOMPADDING',(0,0),(-1,-1),7), ('LEFTPADDING',(0,0),(0,0),8), ])) story.append(bn) story.append(Spacer(1,2)) # Tag tg = Table([[Paragraph(f'<b>{ab["tag"]}</b>', S('',fontName='Helvetica-Bold',fontSize=9,textColor=WHITE,alignment=TA_CENTER))]], colWidths=[16.5*cm]) tg.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),ab['tag_color']), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3)])) story.append(tg) story.append(Spacer(1,4)) # ECG image pil = PILImage.open(ab['img']); iw,ih = pil.size sc = min(16.5*cm/iw, 10.0*cm/ih) ri = RLImage(ab['img'], width=iw*sc, height=ih*sc); ri.hAlign='CENTER' it = Table([[ri]], colWidths=[16.5*cm]) it.setStyle(TableStyle([ ('ALIGN',(0,0),(-1,-1),'CENTER'), ('BOX',(0,0),(-1,-1),2,col), ('BACKGROUND',(0,0),(-1,-1),colors.HexColor('#1a1a1a')), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ])) story.append(it) story.append(Spacer(1,2)) story.append(Paragraph( '<i>Annotation key: Red = Abnormal Finding | Cyan = Key Measurement | Yellow = Arrow Highlight | Orange = Secondary Change</i>', S('',fontName='Helvetica-Oblique',fontSize=7,textColor=colors.HexColor('#546E7A'),alignment=TA_CENTER))) story.append(Spacer(1,4)) # Mechanism box mech = Table([[Paragraph(f'<b>MECHANISM:</b> {ab["mechanism"]}', S('',fontName='Helvetica',fontSize=9,textColor=colors.HexColor('#1A237E'),leading=12))]], colWidths=[16.5*cm]) mech.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),colors.HexColor('#E8EAF6')), ('BOX',(0,0),(-1,-1),1,BLUE), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5), ('LEFTPADDING',(0,0),(-1,-1),9),('RIGHTPADDING',(0,0),(-1,-1),9), ])) story.append(mech) story.append(Spacer(1,4)) # Two col: description + bullets left_items = [Paragraph('<b>REFERENCE</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=BLUE,spaceAfter=3))] left_items.append(Paragraph(ab['ref'],S('',fontName='Helvetica-Oblique',fontSize=8,textColor=colors.HexColor('#37474F'),leading=12))) right_items = [Paragraph('<b>KEY ECG FEATURES</b>',S('',fontName='Helvetica-Bold',fontSize=8,textColor=RED,spaceAfter=3))] for b in ab['bullets']: right_items.append(Paragraph(f'- {b}', bul)) def bx(items, bg, w): inner = Table([[p] for p in items], colWidths=[w]) inner.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),bg), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),3), ('LEFTPADDING',(0,0),(-1,-1),7),('RIGHTPADDING',(0,0),(-1,-1),7), ])) return inner two = Table([[bx(left_items,L_BLUE,7.6*cm), bx(right_items,L_ORNG,7.6*cm)]], colWidths=[8.0*cm,8.5*cm]) two.setStyle(TableStyle([ ('VALIGN',(0,0),(-1,-1),'TOP'), ('LEFTPADDING',(0,0),(-1,-1),0),('RIGHTPADDING',(0,0),(-1,-1),0), ('TOPPADDING',(0,0),(-1,-1),0),('BOTTOMPADDING',(0,0),(-1,-1),0), ('LEFTPADDING',(1,0),(1,0),4), ])) story.append(two) story.append(Spacer(1,4)) # Tip tip = Table([[Paragraph(f'<b>CLINICAL TIP:</b> {ab["tip"]}', S('',fontName='Helvetica',fontSize=9.5,textColor=colors.HexColor('#BF360C'),leading=13))]], colWidths=[16.5*cm]) tip.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),L_YELL), ('BOX',(0,0),(-1,-1),1.5,ACCENT), ('LEFTPADDING',(0,0),(-1,-1),10),('RIGHTPADDING',(0,0),(-1,-1),10), ('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5), ])) story.append(tip) story.append(PageBreak()) # ═══ SUMMARY TABLE ════════════════════════════════════════════════════════════ story.append(Spacer(1,0.4*cm)) story.append(Paragraph('MASTER ECG SUMMARY TABLE', S('',fontName='Helvetica-Bold',fontSize=18,textColor=WHITE,alignment=TA_CENTER,spaceAfter=4))) story.append(Paragraph("All Common ECG Abnormalities at a Glance", S('',fontName='Helvetica',fontSize=10,textColor=ECG_GREEN,alignment=TA_CENTER,spaceAfter=6))) story.append(Spacer(1,0.3*cm)) srows = [[Paragraph('#',tH), Paragraph('Condition',tH), Paragraph('Rate',tH), Paragraph('Rhythm',tH), Paragraph('P Wave',tH), Paragraph('QRS',tH), Paragraph('Key Feature',tH)]] sdata = [ ('1','Normal Sinus','60-100','Regular','Normal (upright)','<120ms','PR 120-200ms; QT <440ms'), ('2','STEMI','Normal/Fast','Regular','Normal','Normal','ST elevation >=2mm (convex) + reciprocal depression'), ('3','Atrial Fibrillation','Variable 100-160','Irregularly irregular','ABSENT (f waves)','Normal/wide','No two RR intervals equal'), ('4','Atrial Flutter','150 (2:1)','Regular or variable','Sawtooth (F waves)','Normal','Atrial rate 300; sawtooth inferior leads'), ('5','LBBB','Normal','Regular','Normal','WIDE >120ms','Broad R in I,aVL,V5-V6; rS in V1; WILLIAM'), ('6','RBBB','Normal','Regular','Normal','WIDE >120ms',"rSR' in V1; slurred S in I,V5-V6; MaRRoW"), ('7','3rd Degree HB','30-40','Regular (slow)','Independent','WIDE (escape)','P & QRS march independently (AV dissociation)'), ('8','Ventricular Tachy','100-250','Regular','Independent (dissociated)','WIDE >120ms','AV dissociation; fusion/capture beats'), ('9','WPW','Normal','Regular','Normal','WIDE (delta)','Short PR <120ms + delta wave + pseudo-Q inferior'), ('10','Hyperkalemia','Normal','Regular then VF','Flattened/absent','Normal then WIDE','Peaked T waves -> wide QRS -> sine wave'), ('11','Long QT / TdP','Fast (TdP)','Polymorphic VT','Normal','Normal then polymorphic','QTc >500ms; TdP = twisting QRS axis'), ('12','Junctional Tachy','60-150','Regular','Retrograde (inverted, after QRS)','NARROW <120ms','Short RP interval; pseudo-S in II (AVNRT)'), ] for r in sdata: srows.append([Paragraph(r[0],S('',fontName='Helvetica-Bold',fontSize=8,textColor=YELL,alignment=TA_CENTER))] + [Paragraph(c,S('',fontName='Helvetica',fontSize=8,textColor=colors.HexColor('#212121'),alignment=TA_CENTER)) for c in r[1:]]) st = Table(srows, colWidths=[0.6*cm,3.0*cm,1.5*cm,2.0*cm,2.5*cm,1.8*cm,5.1*cm], repeatRows=1) st.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,0),DARK), ('ROWBACKGROUNDS',(0,1),(-1,-1),[L_BLUE,WHITE]), ('GRID',(0,0),(-1,-1),0.5,colors.HexColor('#B0BEC5')), ('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4), ('LEFTPADDING',(0,0),(-1,-1),4),('RIGHTPADDING',(0,0),(-1,-1),4), ('VALIGN',(0,0),(-1,-1),'MIDDLE'), ('ALIGN',(6,1),(6,-1),'LEFT'), ])) story.append(st) story.append(Spacer(1,0.5*cm)) # Golden rules rules = [ '1. Rate: 300 / (# large boxes between R peaks). One large box = 0.2s.', '2. Wide complex tachycardia = ALWAYS presume VT. Never give verapamil.', '3. AF = irregularly irregular + absent P waves. Rate control + anticoagulation (CHA2DS2-VASc).', '4. STEMI = convex ST elevation + reciprocal depression. Door-to-balloon < 90 mins.', '5. New LBBB + chest pain = STEMI equivalent. Activate Cath Lab!', '6. WPW + AF = dangerous. NEVER give AV nodal blockers. Cardiovert or use procainamide.', '7. 3rd degree block = P waves march independently of QRS. Needs pacemaker urgently.', '8. QTc > 500ms = high TdP risk. Treat with IV Mg2+. Stop QT-prolonging drugs.', '9. Hyperkalemia: Peaked T -> flat P -> wide QRS -> sine wave -> VF. Treat: C-BIG-K.', '10. Atrial Flutter at 150 bpm: give adenosine to unmask sawtooth flutter waves.', ] rrows = [[Paragraph('<b>THE GOLDEN RULES OF ECG INTERPRETATION (Harrison\'s 22E)</b>', S('',fontName='Helvetica-Bold',fontSize=11,textColor=YELL,spaceAfter=5))]] for r in rules: rrows.append([Paragraph(r, S('',fontName='Helvetica',fontSize=9.5,textColor=WHITE,leading=14))]) rt = Table(rrows, colWidths=[16.5*cm]) rt.setStyle(TableStyle([ ('BACKGROUND',(0,0),(-1,-1),DARK), ('TOPPADDING',(0,0),(-1,-1),3),('BOTTOMPADDING',(0,0),(-1,-1),3), ('LEFTPADDING',(0,0),(-1,-1),14),('RIGHTPADDING',(0,0),(-1,-1),14), ('TOPPADDING',(0,0),(0,0),10),('BOTTOMPADDING',(-1,-1),(-1,-1),10), ])) story.append(rt) doc.build(story, onFirstPage=on_page, onLaterPages=on_page) sz = os.path.getsize(OUTPUT) print(f'PDF created: {OUTPUT} ({sz//1024} KB)') PYEOF