ISUOG 20 week anomaly scan ultrasound report guidelines 2024 parameters

https://www.isuog.org/static/4e2ed89e-fa8a-42c2-9c0929cd89cb…

ICRI India anomaly scan report format 20 weeks second trimester guidelines

PC-PNDT Act 2024 Form F ultrasound report mandatory fields requirements India

https://nhmmeghalaya.nic.in/programmes/pcpndt/form-f.pdf

bilateral lower limb varicose veins venous duplex doppler ultrasound report format SVS AVF guidelines 2024

venous duplex ultrasound varicose veins report template deep superficial perforator reflux CEAP GSV SSV

mkdir -p /home/daytona/workspace/varicose-doppler && ls /home/daytona/workspace/…

~/varicose-doppler/generate_report.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT
from reportlab.platypus import PageBreak

OUTPUT = "/home/daytona/workspace/varicose-doppler/Varicose_Veins_Doppler_Report.pdf"

# ── Colours ──────────────────────────────────────────────────────────────────
DARK_BLUE  = colors.HexColor("#1a3a5c")
MID_BLUE   = colors.HexColor("#2563a8")
LIGHT_BLUE = colors.HexColor("#dbeafe")
HEADER_BG  = colors.HexColor("#0f2d52")
ROW_ALT    = colors.HexColor("#f0f5fb")
BORDER     = colors.HexColor("#93c5fd")
TEXT_DARK  = colors.HexColor("#1e293b")
ORANGE     = colors.HexColor("#d97706")
WHITE      = colors.white

W, H = A4
ML = MR = 14*mm
MT = MB = 12*mm

styles = getSampleStyleSheet()

def S(name, **kw):
    base = styles[name]
    return ParagraphStyle(name + str(id(kw)), parent=base, **kw)

# ── Style helpers ─────────────────────────────────────────────────────────────
TITLE  = S("Title",  fontSize=15, textColor=WHITE,    alignment=TA_CENTER, spaceAfter=2)
SUB    = S("Normal", fontSize=9,  textColor=LIGHT_BLUE, alignment=TA_CENTER, spaceAfter=1)
SEC    = S("Normal", fontSize=10, textColor=WHITE,    fontName="Helvetica-Bold",
           alignment=TA_LEFT, leftIndent=4, spaceAfter=0, spaceBefore=0)
BODY   = S("Normal", fontSize=8,  textColor=TEXT_DARK, leading=11)
BOLD   = S("Normal", fontSize=8,  textColor=TEXT_DARK, fontName="Helvetica-Bold", leading=11)
ITALIC = S("Normal", fontSize=7.5,textColor=colors.HexColor("#475569"), leading=10)
CELL   = S("Normal", fontSize=7.5,textColor=TEXT_DARK, leading=10)
CELL_B = S("Normal", fontSize=7.5,textColor=TEXT_DARK, fontName="Helvetica-Bold", leading=10)
CELL_H = S("Normal", fontSize=7.5,textColor=WHITE,     fontName="Helvetica-Bold",
           leading=10, alignment=TA_CENTER)
NOTE   = S("Normal", fontSize=7,  textColor=colors.HexColor("#64748b"), leading=9)
IMPRS  = S("Normal", fontSize=8,  textColor=DARK_BLUE, fontName="Helvetica-Bold",
           leading=11, leftIndent=4)

def section_bar(title):
    tbl = Table([[Paragraph(title, SEC)]], colWidths=[W - ML - MR])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), MID_BLUE),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ]))
    return tbl

def header_row(*cols):
    return [Paragraph(c, CELL_H) for c in cols]

def trow(*cols, bold=False):
    st = CELL_B if bold else CELL
    return [Paragraph(str(c), st) for c in cols]

def blank_field(label, width=55*mm):
    return f"{label}: {'_'*30}"

DOTTED = "_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _"

def field_table(pairs, col1=65*mm, col2=None):
    col2 = col2 or (W - ML - MR - col1)
    rows = [[Paragraph(f"<b>{k}</b>", CELL), Paragraph(v, CELL)] for k, v in pairs]
    tbl = Table(rows, colWidths=[col1, col2])
    tbl.setStyle(TableStyle([
        ("GRID",           (0,0), (-1,-1), 0.3, BORDER),
        ("BACKGROUND",     (0,0), (0,-1), ROW_ALT),
        ("TOPPADDING",     (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",  (0,0), (-1,-1), 3),
        ("LEFTPADDING",    (0,0), (-1,-1), 4),
    ]))
    return tbl

def vein_table(rows_data, col_widths, header):
    rows = [header_row(*header)]
    for i, r in enumerate(rows_data):
        row = trow(*r)
        rows.append(row)
    tbl = Table(rows, colWidths=col_widths)
    style = [
        ("BACKGROUND",    (0,0), (-1,0), DARK_BLUE),
        ("GRID",          (0,0), (-1,-1), 0.3, BORDER),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 3),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, ROW_ALT]),
    ]
    tbl.setStyle(TableStyle(style))
    return tbl

# ─────────────────────────────────────────────────────────────────────────────
# PAGE TEMPLATE – header/footer
# ─────────────────────────────────────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    # Header band
    canvas.setFillColor(HEADER_BG)
    canvas.rect(0, H - 28*mm, W, 28*mm, fill=1, stroke=0)
    canvas.setFillColor(WHITE)
    canvas.setFont("Helvetica-Bold", 13)
    canvas.drawCentredString(W/2, H - 12*mm,
        "VENOUS DUPLEX DOPPLER ULTRASOUND REPORT")
    canvas.setFont("Helvetica", 8)
    canvas.setFillColor(LIGHT_BLUE)
    canvas.drawCentredString(W/2, H - 19*mm,
        "Bilateral Lower Limb Varicose Veins / Chronic Venous Disease Assessment")
    canvas.drawCentredString(W/2, H - 24*mm,
        "SVS/AVF/AVLS 2023 Guidelines  |  2020 CEAP Classification  |  UIP Consensus")
    # Footer
    canvas.setFillColor(HEADER_BG)
    canvas.rect(0, 0, W, 10*mm, fill=1, stroke=0)
    canvas.setFillColor(LIGHT_BLUE)
    canvas.setFont("Helvetica", 7)
    canvas.drawString(ML, 3.5*mm,
        "Reflux thresholds: Superficial/Perforators >500 ms  |  Deep veins (CFV/FV/POPV) >1000 ms  |  Pathological perforator: ≥3.5 mm & ≥500 ms outward flow")
    canvas.drawRightString(W - MR, 3.5*mm, f"Page {doc.page}")
    canvas.restoreState()

# ─────────────────────────────────────────────────────────────────────────────
# BUILD STORY
# ─────────────────────────────────────────────────────────────────────────────
story = []
SP = lambda n=4: Spacer(1, n*mm)

# ══ SECTION 1: Patient & Referral ════════════════════════════════════════════
story += [SP(2), section_bar("SECTION 1 — PATIENT & REFERRAL DETAILS"), SP(2)]
story += [field_table([
    ("Patient Name",        DOTTED),
    ("Age / Sex",           DOTTED),
    ("Reg. / MRD No.",      DOTTED),
    ("Date of Scan",        DOTTED),
    ("Referred By",         "Dr. " + DOTTED),
    ("Clinical Indication", "Bilateral lower limb varicose veins / leg swelling / leg pain / venous ulcer / pre-treatment mapping"),
    ("Previous Treatment",  "None  ☐  |  Sclerotherapy  ☐  |  EVLA  ☐  |  Surgery  ☐   Specify: " + DOTTED),
], col1=68*mm), SP(3)]

# ══ SECTION 2: Technique ═════════════════════════════════════════════════════
story += [section_bar("SECTION 2 — TECHNIQUE & EQUIPMENT"), SP(2)]
story += [field_table([
    ("Machine / Model",       DOTTED),
    ("Transducer",            "Linear high-frequency  7.5 – 15 MHz"),
    ("Patient Position",      "Standing / Reverse Trendelenburg  ☐   Supine  ☐"),
    ("Compression Method",    "Manual calf squeeze  ☐   Pneumatic cuff deflation  ☐"),
    ("Valsalva Manoeuvre",    "Yes  ☐   No  ☐   (used for SFJ / CFV assessment)"),
    ("Modes Used",            "B-mode (greyscale) + Colour Doppler + Spectral Doppler (Duplex)"),
    ("Scan Performed By",     DOTTED),
    ("Interpreted By",        DOTTED),
], col1=68*mm)]
story += [SP(2), Paragraph(
    "<b>Reflux Threshold (SVS/AVF/AVLS 2023):</b>  Superficial veins & perforators: <b>&gt;500 ms</b> retrograde flow.  "
    "Deep veins (CFV, FV, POPV): <b>&gt;1000 ms</b> retrograde flow.  "
    "Pathological perforator: diameter <b>≥3.5 mm</b> AND outward flow <b>≥500 ms</b>.", ITALIC), SP(3)]

# ══ Helper: deep vein table ═══════════════════════════════════════════════════
deep_veins = [
    ("Common Femoral Vein (CFV)",   "Yes ☐  No ☐", "Phasic / Non-phasic", "Present / Absent", "_______ ms", "Normal / Reflux"),
    ("Femoral Vein – proximal",     "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Femoral Vein – mid",          "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Femoral Vein – distal",       "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Deep Femoral V. (Profunda)",  "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Popliteal Vein (POPV)",       "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Posterior Tibial Veins",      "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Peroneal Veins",              "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Anterior Tibial Veins",       "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Gastrocnemius Veins",         "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
    ("Soleal Veins",                "Yes ☐  No ☐", "", "", "_______ ms", "Normal / Reflux"),
]
deep_hdr  = ["Vein Segment", "Compressible", "Flow", "Augmentation", "Reflux Duration", "Interpretation"]
deep_cols = [52*mm, 22*mm, 28*mm, 26*mm, 26*mm, 28*mm]

gsv_rows = [
    ("GSV – groin / proximal thigh", "_______ mm", "Yes ☐  No ☐", "_______ ms", "Yes ☐  No ☐"),
    ("GSV – mid thigh",              "_______ mm", "Yes ☐  No ☐", "_______ ms", "Yes ☐  No ☐"),
    ("GSV – distal thigh",           "_______ mm", "Yes ☐  No ☐", "_______ ms", "Yes ☐  No ☐"),
    ("GSV – above knee",             "_______ mm", "Yes ☐  No ☐", "_______ ms", "Yes ☐  No ☐"),
    ("GSV – below knee",             "_______ mm", "Yes ☐  No ☐", "_______ ms", "Yes ☐  No ☐"),
    ("GSV – ankle level",            "_______ mm", "Yes ☐  No ☐", "_______ ms", "Yes ☐  No ☐"),
]
gsv_hdr  = ["GSV Segment", "Diameter (mm)", "In Saphenous Canal", "Reflux Duration", "Reflux Present"]
gsv_cols = [52*mm, 28*mm, 34*mm, 30*mm, 28*mm]

ssv_rows = [
    ("SSV – upper calf", "_______ mm", "_______ ms", "Yes ☐  No ☐"),
    ("SSV – mid calf",   "_______ mm", "_______ ms", "Yes ☐  No ☐"),
    ("SSV – lower calf", "_______ mm", "_______ ms", "Yes ☐  No ☐"),
]
ssv_hdr  = ["SSV Segment", "Diameter (mm)", "Reflux Duration", "Reflux Present"]
ssv_cols = [55*mm, 35*mm, 40*mm, 42*mm]

perforator_rows = [
    ("Medial thigh",         "_______ cm from groin",         "_______ mm", "_______ ms", "GSV / Tributary",  "Yes ☐  No ☐"),
    ("Hunterian perforator", "Mid thigh",                     "_______ mm", "_______ ms", "GSV / FV",         "Yes ☐  No ☐"),
    ("Dodd's perforator",    "Distal thigh",                  "_______ mm", "_______ ms", "GSV / FV",         "Yes ☐  No ☐"),
    ("Boyd's perforator",    "Below knee",                    "_______ mm", "_______ ms", "GSV / PT",         "Yes ☐  No ☐"),
    ("Cockett I",            "Medial ankle – lower",          "_______ mm", "_______ ms", "Post. arch / GSV", "Yes ☐  No ☐"),
    ("Cockett II",           "Medial ankle – mid",            "_______ mm", "_______ ms", "Post. arch / GSV", "Yes ☐  No ☐"),
    ("Cockett III",          "Medial ankle – upper",          "_______ mm", "_______ ms", "Post. arch / GSV", "Yes ☐  No ☐"),
    ("Posterior tibial",     "Medial leg",                    "_______ mm", "_______ ms", "",                 "Yes ☐  No ☐"),
    ("Paratibial",           "Medial leg",                    "_______ mm", "_______ ms", "",                 "Yes ☐  No ☐"),
    ("Lateral leg",          "Lateral calf",                  "_______ mm", "_______ ms", "SSV / Tributary",  "Yes ☐  No ☐"),
]
perf_hdr  = ["Perforator", "Location", "Diameter", "Outward Flow", "Connecting to", "Significant"]
perf_cols = [32*mm, 36*mm, 22*mm, 22*mm, 30*mm, 22*mm+2*mm]  # tight but fits

varic_rows = [
    ("Medial thigh",       "Present ☐  Absent ☐", "_______ mm", "GSV trunk / AAGSV / perforator"),
    ("Medial leg",         "Present ☐  Absent ☐", "_______ mm", "GSV / Cockett perforator"),
    ("Lateral thigh",      "Present ☐  Absent ☐", "_______ mm", "SSV / LAGSV"),
    ("Posterior calf",     "Present ☐  Absent ☐", "_______ mm", "SSV / perforator"),
    ("Anterior leg",       "Present ☐  Absent ☐", "_______ mm", "_________________"),
    ("Ankle / gaiter zone","Present ☐  Absent ☐", "_______ mm", "Cockett perforator"),
]
varic_hdr  = ["Location", "Distribution", "Approx. Diameter", "Source of Filling"]
varic_cols = [40*mm, 38*mm, 35*mm, 55*mm+14*mm]  # proportional

skin_rows = [
    ("Pitting oedema",          "Present ☐  Absent ☐", ""),
    ("Haemosiderin / pigmentation","Present ☐  Absent ☐","Site: _________________"),
    ("Lipodermatosclerosis",    "Present ☐  Absent ☐", "Site: _________________"),
    ("Corona phlebectatica",    "Present ☐  Absent ☐", "At ankle region"),
    ("Healed ulcer",            "Present ☐  Absent ☐", "Site: _________________"),
    ("Active venous ulcer",     "Present ☐  Absent ☐", "Site / size: ___________"),
    ("Telangiectasias",         "Present ☐  Absent ☐", "Distribution: __________"),
]
skin_hdr  = ["Finding", "Present / Absent", "Details"]
skin_cols = [55*mm, 42*mm, 75*mm]

def build_limb_section(side):
    s = []
    s += [section_bar(f"SECTION {'3' if side=='RIGHT' else '4'} — {side} LOWER LIMB"), SP(2)]

    # Deep
    s += [Paragraph(f"<b>{'3' if side=='RIGHT' else '4'}A.  Deep Venous System – {side}</b>", BOLD), SP(1)]
    s += [vein_table(deep_veins, deep_cols, deep_hdr), SP(1)]
    s += [Paragraph(f"<b>DVT ({side}):</b>  None ☐   Acute DVT at: __________________   Chronic changes at: __________________", CELL), SP(3)]

    # SFJ
    s += [Paragraph(f"<b>{'3' if side=='RIGHT' else '4'}B.  Superficial Venous System – {side}</b>", BOLD), SP(1)]
    s += [Paragraph("<i>Saphenofemoral Junction (SFJ)</i>", ITALIC), SP(1)]
    s += [field_table([
        ("SFJ location",    "_______ cm below inguinal ligament"),
        ("SFJ competence",  "Competent  ☐     Incompetent  ☐"),
        ("Reflux at SFJ",   "No reflux  ☐     Reflux: _______ ms  (Valsalva-provoked)"),
        ("Tributaries at SFJ","Normal  ☐     Accessory saphenous entering  ☐     Other: _______________"),
    ], col1=62*mm), SP(2)]

    # GSV
    s += [Paragraph("<i>Great Saphenous Vein (GSV)</i>", ITALIC), SP(1)]
    s += [vein_table(gsv_rows, gsv_cols, gsv_hdr), SP(1)]
    s += [Paragraph(
        "GSV total refluxing length: _______ cm     |     "
        "GSV wall: Normal ☐   Thickened ☐   Intraluminal echoes ☐   Post-thrombotic ☐", CELL), SP(2)]

    # AAGSV / Giacomini
    s += [field_table([
        ("AAGSV (Anterior Accessory GSV)", "Visible: Yes ☐  No ☐     Diameter: _______ mm     Reflux: _______ ms"),
        ("Giacomini / Posterior Accessory","Visible: Yes ☐  No ☐     Diameter: _______ mm     Reflux: _______ ms"),
    ], col1=68*mm), SP(2)]

    # SPJ / SSV
    s += [Paragraph(f"<b>{'3' if side=='RIGHT' else '4'}C.  Small Saphenous Vein (SSV) & Saphenopopliteal Junction (SPJ) – {side}</b>", BOLD), SP(1)]
    s += [field_table([
        ("SPJ identifiable",  "Yes  ☐     No  ☐   (absent in ~10-30% cases)"),
        ("SPJ level",         "_______ cm above popliteal crease"),
        ("SPJ competence",    "Competent  ☐     Incompetent  ☐"),
        ("Reflux at SPJ",     "No reflux  ☐     Reflux: _______ ms"),
        ("SSV cranial extension (Giacomini)", "Present  ☐     Absent  ☐"),
    ], col1=68*mm), SP(1)]
    s += [vein_table(ssv_rows, ssv_cols, ssv_hdr), SP(1)]
    s += [Paragraph("SSV total refluxing length: _______ cm", CELL), SP(2)]

    # Perforators
    s += [Paragraph(f"<b>{'3' if side=='RIGHT' else '4'}D.  Incompetent Perforating Veins (IPVs) – {side}</b>", BOLD), SP(0.5)]
    s += [Paragraph("<i>Pathological criterion: outward flow ≥500 ms AND diameter ≥3.5 mm  (SVS/AVF/AVLS 2023)</i>", ITALIC), SP(1)]
    s += [vein_table(perforator_rows, perf_cols, perf_hdr), SP(1)]
    s += [Paragraph(f"Total pathological perforators identified ({side}): _______", CELL), SP(2)]

    # Varicosities
    s += [Paragraph(f"<b>{'3' if side=='RIGHT' else '4'}E.  Varicosities – {side}</b>", BOLD), SP(1)]
    s += [vein_table(varic_rows, varic_cols, varic_hdr), SP(2)]

    # Skin
    s += [Paragraph(f"<b>{'3' if side=='RIGHT' else '4'}F.  Skin & Soft Tissue Changes – {side}</b>", BOLD), SP(1)]
    s += [vein_table(skin_rows, skin_cols, skin_hdr), SP(3)]
    return s

story += build_limb_section("RIGHT")
story += [PageBreak()]
story += build_limb_section("LEFT")

# ══ SECTION 5: Reflux Pattern ═════════════════════════════════════════════════
story += [SP(2), section_bar("SECTION 5 — REFLUX PATTERN CLASSIFICATION (BILATERAL SUMMARY)"), SP(2)]
reflux_rows = [
    ("Axial reflux (groin → calf, uninterrupted)",  "Present ☐  Absent ☐", "Present ☐  Absent ☐"),
    ("Junctional reflux only (SFJ or SPJ isolated)","Present ☐  Absent ☐", "Present ☐  Absent ☐"),
    ("Segmental reflux (portion of truncal vein)",  "Present ☐  Absent ☐", "Present ☐  Absent ☐"),
    ("Deep vein reflux",                            "Present ☐  Absent ☐", "Present ☐  Absent ☐"),
    ("Perforator-sourced reflux",                   "Present ☐  Absent ☐", "Present ☐  Absent ☐"),
    ("Pelvic source suspected",                     "Present ☐  Absent ☐", "Present ☐  Absent ☐"),
]
story += [vein_table(reflux_rows, [100*mm, 47*mm, 35*mm],
                     ["Reflux Pattern", "Right", "Left"]), SP(3)]

# ══ SECTION 6: CEAP ══════════════════════════════════════════════════════════
story += [section_bar("SECTION 6 — CEAP CLASSIFICATION  (2020 Updated CEAP – American Venous Forum)"), SP(2)]
ceap_comp = [
    ("C – Clinical class",   "C___ (see table below)", "C___"),
    ("E – Etiology",         "Ep (primary)  ☐   Es (secondary/post-thrombotic)  ☐   Ec (congenital)  ☐",
                              "Ep  ☐   Es  ☐   Ec  ☐"),
    ("A – Anatomy",          "As (superficial)  ☐   Ad (deep)  ☐   Ap (perforator)  ☐",
                              "As  ☐   Ad  ☐   Ap  ☐"),
    ("P – Pathophysiology",  "Pr (reflux)  ☐   Po (obstruction)  ☐   Pr,o (both)  ☐",
                              "Pr  ☐   Po  ☐   Pr,o  ☐"),
]
comp_rows = [[Paragraph(f"<b>{r[0]}</b>", CELL), Paragraph(r[1], CELL), Paragraph(r[2], CELL)] for r in ceap_comp]
comp_tbl = Table([header_row("Component", "Right", "Left")] + comp_rows,
                 colWidths=[35*mm, 105*mm, 42*mm])
comp_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), DARK_BLUE),
    ("GRID",          (0,0), (-1,-1), 0.3, BORDER),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 4),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, ROW_ALT]),
]))
story += [comp_tbl, SP(2)]

ceap_class = [
    ("C0","No visible or palpable signs of venous disease"),
    ("C1","Telangiectasias or reticular veins"),
    ("C2","Varicose veins"),
    ("C2r","Recurrent varicose veins"),
    ("C3","Oedema"),
    ("C4a","Pigmentation or eczema"),
    ("C4b","Lipodermatosclerosis or atrophie blanche"),
    ("C4c","Corona phlebectatica"),
    ("C5","Healed venous ulcer"),
    ("C6","Active venous ulcer"),
    ("C6r","Recurrent active venous ulcer"),
]
cc_rows = [[Paragraph(f"<b>{c[0]}</b>", CELL_B), Paragraph(c[1], CELL)] for c in ceap_class]
# 2-column layout side by side
half = len(cc_rows)//2 + len(cc_rows)%2
left_col  = cc_rows[:half]
right_col = cc_rows[half:]
while len(right_col) < len(left_col):
    right_col.append([Paragraph("", CELL), Paragraph("", CELL)])

merged_rows = [[Paragraph("<b>Class</b>", CELL_H), Paragraph("<b>Description</b>", CELL_H),
                Paragraph("<b>Class</b>", CELL_H), Paragraph("<b>Description</b>", CELL_H)]]
for l, r in zip(left_col, right_col):
    merged_rows.append(l + r)
cc_tbl = Table(merged_rows, colWidths=[14*mm, 80*mm, 14*mm, 74*mm])
cc_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), DARK_BLUE),
    ("GRID",          (0,0), (-1,-1), 0.3, BORDER),
    ("TOPPADDING",    (0,0), (-1,-1), 2),
    ("BOTTOMPADDING", (0,0), (-1,-1), 2),
    ("LEFTPADDING",   (0,0), (-1,-1), 3),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, ROW_ALT]),
]))
story += [cc_tbl, SP(2)]
story += [Paragraph("<b>Suffix:</b>  s = symptomatic (pain, heaviness, swelling, achiness, itching – HASTI)   |   a = asymptomatic", CELL)]
story += [Paragraph("<b>Right CEAP:</b> C___ E___ A___ P___ ( s / a )     "
                    "<b>Left CEAP:</b> C___ E___ A___ P___ ( s / a )", BOLD), SP(3)]

# ══ SECTION 7: Summary ═══════════════════════════════════════════════════════
story += [PageBreak(), section_bar("SECTION 7 — SUMMARY OF FINDINGS"), SP(2)]

for side in ["RIGHT", "LEFT"]:
    story += [Paragraph(f"<b>{side} LOWER LIMB</b>", BOLD), SP(1)]
    rows = [
        ("Deep system",         f"Patent ☐  No DVT ☐     Deep venous reflux: Present ☐  Absent ☐   at: _______________________"),
        ("SFJ",                 "Competent ☐   Incompetent ☐   Reflux: _______ ms"),
        ("GSV",                 "Reflux from __________________ to __________________   Total: _______ cm   Diameter SFJ: _______ mm   BK: _______ mm"),
        ("SSV / SPJ",           "Competent ☐   Incompetent ☐   Reflux: _______ ms   SSV refluxing length: _______ cm"),
        ("Reflux pattern",      "Axial ☐   Junctional ☐   Segmental ☐"),
        ("Pathological IPVs",   "_______ perforator(s) at: _____________________________________________"),
        ("Varicosities",        "Distribution: ______________________   Source: ________________________"),
        ("Skin changes",        "None ☐   Pigmentation ☐   LDS ☐   Corona phlebectatica ☐   Ulcer at: ______________"),
    ]
    tbl = Table([[Paragraph(f"<b>{r[0]}</b>", CELL), Paragraph(r[1], CELL)] for r in rows],
                colWidths=[48*mm, W-ML-MR-48*mm])
    tbl.setStyle(TableStyle([
        ("GRID",           (0,0), (-1,-1), 0.3, BORDER),
        ("BACKGROUND",     (0,0), (0,-1), ROW_ALT),
        ("TOPPADDING",     (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",  (0,0), (-1,-1), 3),
        ("LEFTPADDING",    (0,0), (-1,-1), 4),
    ]))
    story += [tbl, SP(3)]

# ══ SECTION 8: Impression ════════════════════════════════════════════════════
story += [section_bar("SECTION 8 — IMPRESSION"), SP(2)]
for side, n in [("RIGHT","8.1"), ("LEFT","8.2")]:
    box_rows = [
        [Paragraph(f"<b>{n}  {side} LOWER LIMB</b>", IMPRS)],
        [Paragraph(
            f"CEAP: C___ E___ A___ P___ (s/a)<br/>"
            f"Chronic venous insufficiency, {side.lower()} lower limb.<br/>"
            f"[GSV axial reflux  ☐  |  SFJ junctional reflux  ☐  |  SSV reflux  ☐  |  Isolated perforator reflux  ☐]<br/>"
            f"Reflux from ____________________ to ____________________.  Truncal length: _______ cm<br/>"
            f"Deep venous system: Patent ☐   DVT at: ____________________   Chronic changes: ____________________",
            BODY)],
    ]
    imp_tbl = Table(box_rows, colWidths=[W-ML-MR])
    imp_tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (0,0), LIGHT_BLUE),
        ("BACKGROUND",    (0,1), (0,1), WHITE),
        ("BOX",           (0,0), (-1,-1), 0.8, MID_BLUE),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ]))
    story += [imp_tbl, SP(3)]

# ══ SECTION 9: Recommendations ═══════════════════════════════════════════════
story += [section_bar("SECTION 9 — CLINICAL CORRELATION & RECOMMENDATIONS"), SP(2)]
recs = [
    "☐  Findings support conservative management (compression stockings, lifestyle modification) for C2/C3 disease",
    "☐  Patient suitable for endovenous thermal ablation (EVLA / RFA) of GSV – Right ☐  Left ☐  Bilateral ☐",
    "☐  Patient suitable for ultrasound-guided foam sclerotherapy (UGFS) of: ___________________________",
    "☐  Phlebectomy / stab avulsions of varicosities advised",
    "☐  Perforator ablation (MOCA / UGFS) advised for IPVs at: ___________________________________",
    "☐  DVT found – anticoagulation and haematology referral recommended",
    "☐  Deep venous reflux present – refer to vascular surgery for further evaluation",
    "☐  Pelvic source suspected – pelvic venous duplex / CT venography recommended",
    "☐  Pre-treatment anatomical mapping complete for planned intervention",
    "☐  Post-treatment follow-up – occlusion confirmed ☐   Re-canalisation noted ☐",
]
for r in recs:
    story += [Paragraph(r, BODY)]
story += [SP(3)]

# ══ SECTION 10: Technical Quality ════════════════════════════════════════════
story += [section_bar("SECTION 10 — TECHNICAL QUALITY"), SP(2)]
techs = [
    "☐  Technically satisfactory – all segments adequately assessed",
    "☐  Suboptimal assessment of: ____________________ due to: oedema / pain / obesity / wound dressing",
    "☐  Standing position not tolerated; scan performed supine – may underestimate reflux",
    "☐  Images archived to PACS / printed and filed",
]
for t in techs:
    story += [Paragraph(t, BODY)]
story += [SP(3)]

# ══ Authorisation ═════════════════════════════════════════════════════════════
story += [section_bar("AUTHORISATION"), SP(2)]
story += [field_table([
    ("Report Prepared By",    DOTTED),
    ("Qualification",         "MD Radiology / DNB Radiology / DMRD / MS Vascular Surgery"),
    ("MCI / NMC Reg. No.",    DOTTED),
    ("Date & Time of Report", DOTTED),
    ("Signature & Stamp",     ""),
    ("Centre Name & Address", DOTTED),
], col1=65*mm), SP(3)]

# ══ Disclaimer ════════════════════════════════════════════════════════════════
story += [HRFlowable(width="100%", thickness=0.5, color=MID_BLUE), SP(2)]
story += [Paragraph(
    "<b>DISCLAIMER:</b>  This report constitutes a screening/diagnostic duplex ultrasound examination. "
    "A normal study does not exclude all venous pathology. Results are position- and technique-dependent; "
    "reflux may be underestimated in the supine position. All findings must be correlated with clinical history, "
    "physical examination, and symptom severity (HASTI). Surveillance imaging is recommended for progressive disease. "
    "References: SVS/AVF/AVLS 2023 Varicose Vein Guidelines (PMID 37652254) | 2020 CEAP Update (AVF) | "
    "UIP Duplex Consensus Document | ACR Duplex Ultrasound Standards.",
    ITALIC), SP(2)]

# ─────────────────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=ML, rightMargin=MR,
    topMargin=34*mm, bottomMargin=16*mm,
    title="Bilateral Lower Limb Varicose Veins Doppler Report",
    author="Orris Medical Reports",
    subject="Venous Duplex Doppler Ultrasound",
)
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print("PDF created:", OUTPUT)

cd /home/daytona/workspace/varicose-doppler && python generate_report.py 2>&1

ls -lh /home/daytona/workspace/varicose-doppler/Varicose_Veins_Doppler_Report.pd…

node -e "require('docx'); console.log('docx ok')" 2>&1 | head -3

~/varicose-doppler/generate_report.js

"use strict";
const fs = require("fs");
const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  Header, Footer, AlignmentType, HeadingLevel, BorderStyle, WidthType,
  ShadingType, VerticalAlign, PageNumber, NumberFormat,
  convertInchesToTwip, convertMillimetersToTwip, PageBreak,
} = require("docx");

// ── Colours ────────────────────────────────────────────────────────────────
const C = {
  darkBlue:  "1a3a5c",
  midBlue:   "2563a8",
  lightBlue: "dbeafe",
  headerBg:  "0f2d52",
  rowAlt:    "f0f5fb",
  white:     "FFFFFF",
  textDark:  "1e293b",
  orange:    "d97706",
  grey:      "64748b",
};

// ── Helpers ────────────────────────────────────────────────────────────────
const mm  = convertMillimetersToTwip;
const twp = convertInchesToTwip;

function shading(hex) {
  return { type: ShadingType.SOLID, color: hex, fill: hex };
}

function borders(color = C.midBlue, sz = 4) {
  const b = { style: BorderStyle.SINGLE, size: sz, color };
  return { top: b, bottom: b, left: b, right: b };
}

function noBorders() {
  const b = { style: BorderStyle.NONE, size: 0, color: "FFFFFF" };
  return { top: b, bottom: b, left: b, right: b };
}

// ── Text helpers ───────────────────────────────────────────────────────────
function run(text, opts = {}) {
  return new TextRun({ text, font: "Calibri", size: opts.size || 18,
    bold: opts.bold || false, italics: opts.italic || false,
    color: opts.color || C.textDark, ...opts });
}

function para(children, opts = {}) {
  const c = typeof children === "string" ? [run(children, opts)] : children;
  return new Paragraph({
    children: c,
    alignment: opts.align || AlignmentType.LEFT,
    spacing: { before: opts.spaceBefore || 40, after: opts.spaceAfter || 40 },
    indent: opts.indent ? { left: mm(opts.indent) } : undefined,
  });
}

function emptyPara(space = 60) {
  return new Paragraph({ children: [], spacing: { before: 0, after: space } });
}

// ── Section bar (shaded heading row) ──────────────────────────────────────
function sectionBar(title) {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [new TableRow({
      children: [new TableCell({
        children: [new Paragraph({
          children: [run(title, { bold: true, color: C.white, size: 20 })],
          spacing: { before: 60, after: 60 },
          indent: { left: mm(3) },
        })],
        shading: shading(C.midBlue),
        borders: noBorders(),
        margins: { left: mm(2), right: mm(2) },
      })],
    })],
    borders: { top: noBorders().top, bottom: noBorders().bottom,
               left: noBorders().left, right: noBorders().right,
               insideH: noBorders().top, insideV: noBorders().left },
  });
}

// ── 2-column field table (label | value) ──────────────────────────────────
function fieldTable(pairs, labelWidthPct = 30) {
  const rows = pairs.map(([label, value], i) => new TableRow({
    children: [
      new TableCell({
        children: [para([run(label, { bold: true, size: 17, color: C.darkBlue })], { spaceBefore: 30, spaceAfter: 30 })],
        width: { size: labelWidthPct, type: WidthType.PERCENTAGE },
        shading: shading(i % 2 === 0 ? C.rowAlt : C.white),
        borders: borders(C.midBlue, 3),
        margins: { left: mm(2), right: mm(2) },
        verticalAlign: VerticalAlign.CENTER,
      }),
      new TableCell({
        children: [para(value || "________________________________", { spaceBefore: 30, spaceAfter: 30 })],
        width: { size: 100 - labelWidthPct, type: WidthType.PERCENTAGE },
        shading: shading(i % 2 === 0 ? C.white : C.rowAlt),
        borders: borders(C.midBlue, 3),
        margins: { left: mm(2), right: mm(2) },
        verticalAlign: VerticalAlign.CENTER,
      }),
    ],
  }));
  return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows });
}

// ── Generic data table ─────────────────────────────────────────────────────
function dataTable(headers, rows, colPcts) {
  const headerRow = new TableRow({
    tableHeader: true,
    children: headers.map((h, i) => new TableCell({
      children: [new Paragraph({
        children: [run(h, { bold: true, color: C.white, size: 16 })],
        alignment: AlignmentType.CENTER,
        spacing: { before: 40, after: 40 },
      })],
      shading: shading(C.darkBlue),
      borders: borders(C.white, 4),
      width: { size: colPcts[i], type: WidthType.PERCENTAGE },
      margins: { left: mm(1.5), right: mm(1.5) },
      verticalAlign: VerticalAlign.CENTER,
    })),
  });

  const dataRows = rows.map((row, ri) => new TableRow({
    children: row.map((cell, ci) => new TableCell({
      children: [new Paragraph({
        children: [run(String(cell), { size: 16, color: C.textDark })],
        spacing: { before: 30, after: 30 },
      })],
      shading: shading(ri % 2 === 0 ? C.white : C.rowAlt),
      borders: borders(C.midBlue, 3),
      width: { size: colPcts[ci], type: WidthType.PERCENTAGE },
      margins: { left: mm(1.5), right: mm(1.5) },
      verticalAlign: VerticalAlign.CENTER,
    })),
  }));

  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [headerRow, ...dataRows],
  });
}

// ── Sub-heading paragraph ──────────────────────────────────────────────────
function subHead(text) {
  return new Paragraph({
    children: [run(text, { bold: true, size: 18, color: C.darkBlue })],
    spacing: { before: 120, after: 40 },
  });
}
function subHeadItalic(text) {
  return new Paragraph({
    children: [run(text, { italic: true, size: 17, color: C.midBlue })],
    spacing: { before: 80, after: 30 },
  });
}
function note(text) {
  return new Paragraph({
    children: [run(text, { italic: true, size: 15, color: C.grey })],
    spacing: { before: 20, after: 60 },
  });
}
function bullet(text) {
  return new Paragraph({
    children: [run(text, { size: 17 })],
    spacing: { before: 20, after: 20 },
    indent: { left: mm(6) },
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// DATA DEFINITIONS
// ─────────────────────────────────────────────────────────────────────────────
const DOTTED = "________________________________";

const deepVeins = [
  ["Common Femoral Vein (CFV)",   "Yes ☐  No ☐", "Phasic / Non-phasic", "Present / Absent", "_______ ms", "Normal / Reflux"],
  ["Femoral Vein – proximal",     "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Femoral Vein – mid",          "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Femoral Vein – distal",       "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Deep Femoral V. (Profunda)",  "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Popliteal Vein (POPV)",       "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Posterior Tibial Veins",      "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Peroneal Veins",              "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Anterior Tibial Veins",       "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Gastrocnemius Veins",         "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
  ["Soleal Veins",                "Yes ☐  No ☐", "",                    "",                  "_______ ms", "Normal / Reflux"],
];
const deepHdr  = ["Vein Segment","Compressible","Flow","Augmentation","Reflux Duration","Interpretation"];
const deepCols = [24, 13, 15, 16, 16, 16];

const gsvRows = [
  ["GSV – groin / proximal thigh","_______ mm","Yes ☐  No ☐","_______ ms","Yes ☐  No ☐"],
  ["GSV – mid thigh",             "_______ mm","Yes ☐  No ☐","_______ ms","Yes ☐  No ☐"],
  ["GSV – distal thigh",          "_______ mm","Yes ☐  No ☐","_______ ms","Yes ☐  No ☐"],
  ["GSV – above knee",            "_______ mm","Yes ☐  No ☐","_______ ms","Yes ☐  No ☐"],
  ["GSV – below knee",            "_______ mm","Yes ☐  No ☐","_______ ms","Yes ☐  No ☐"],
  ["GSV – ankle level",           "_______ mm","Yes ☐  No ☐","_______ ms","Yes ☐  No ☐"],
];
const gsvHdr  = ["GSV Segment","Diameter (mm)","In Saphenous Canal","Reflux Duration","Reflux Present"];
const gsvCols = [28, 18, 22, 18, 14];

const ssvRows = [
  ["SSV – upper calf","_______ mm","_______ ms","Yes ☐  No ☐"],
  ["SSV – mid calf",  "_______ mm","_______ ms","Yes ☐  No ☐"],
  ["SSV – lower calf","_______ mm","_______ ms","Yes ☐  No ☐"],
];
const ssvHdr  = ["SSV Segment","Diameter (mm)","Reflux Duration","Reflux Present"];
const ssvCols = [30, 24, 26, 20];

const perfRows = [
  ["Medial thigh",          "_______ cm from groin",   "_______ mm","_______ ms","GSV / Tributary",   "Yes ☐  No ☐"],
  ["Hunterian perforator",  "Mid thigh",               "_______ mm","_______ ms","GSV / FV",          "Yes ☐  No ☐"],
  ["Dodd's perforator",     "Distal thigh",            "_______ mm","_______ ms","GSV / FV",          "Yes ☐  No ☐"],
  ["Boyd's perforator",     "Below knee",              "_______ mm","_______ ms","GSV / PT",          "Yes ☐  No ☐"],
  ["Cockett I",             "Medial ankle – lower",    "_______ mm","_______ ms","Post. arch / GSV",  "Yes ☐  No ☐"],
  ["Cockett II",            "Medial ankle – mid",      "_______ mm","_______ ms","Post. arch / GSV",  "Yes ☐  No ☐"],
  ["Cockett III",           "Medial ankle – upper",    "_______ mm","_______ ms","Post. arch / GSV",  "Yes ☐  No ☐"],
  ["Posterior tibial",      "Medial leg",              "_______ mm","_______ ms","",                  "Yes ☐  No ☐"],
  ["Paratibial",            "Medial leg",              "_______ mm","_______ ms","",                  "Yes ☐  No ☐"],
  ["Lateral leg",           "Lateral calf",            "_______ mm","_______ ms","SSV / Tributary",   "Yes ☐  No ☐"],
];
const perfHdr  = ["Perforator","Location","Diameter","Outward Flow","Connecting to","Significant"];
const perfCols = [18, 22, 12, 14, 19, 15];

const varicRows = [
  ["Medial thigh",        "Present ☐  Absent ☐","_______ mm","GSV trunk / AAGSV / perforator"],
  ["Medial leg",          "Present ☐  Absent ☐","_______ mm","GSV / Cockett perforator"],
  ["Lateral thigh",       "Present ☐  Absent ☐","_______ mm","SSV / LAGSV"],
  ["Posterior calf",      "Present ☐  Absent ☐","_______ mm","SSV / perforator"],
  ["Anterior leg",        "Present ☐  Absent ☐","_______ mm","_________________"],
  ["Ankle / gaiter zone", "Present ☐  Absent ☐","_______ mm","Cockett perforator"],
];
const varicHdr  = ["Location","Distribution","Approx. Diameter","Source of Filling"];
const varicCols = [22, 26, 22, 30];

const skinRows = [
  ["Pitting oedema",             "Present ☐  Absent ☐",""],
  ["Haemosiderin / pigmentation","Present ☐  Absent ☐","Site: _________________"],
  ["Lipodermatosclerosis",       "Present ☐  Absent ☐","Site: _________________"],
  ["Corona phlebectatica",       "Present ☐  Absent ☐","At ankle region"],
  ["Healed ulcer",               "Present ☐  Absent ☐","Site: _________________"],
  ["Active venous ulcer",        "Present ☐  Absent ☐","Site / size: ___________"],
  ["Telangiectasias",            "Present ☐  Absent ☐","Distribution: __________"],
];
const skinHdr  = ["Finding","Present / Absent","Details"];
const skinCols = [30, 30, 40];

// ─────────────────────────────────────────────────────────────────────────────
// PER-LIMB CONTENT BUILDER
// ─────────────────────────────────────────────────────────────────────────────
function buildLimb(side, secNum) {
  const items = [];
  items.push(sectionBar(`SECTION ${secNum} — ${side} LOWER LIMB`));

  // Deep
  items.push(subHead(`${secNum}A.  Deep Venous System – ${side}`));
  items.push(dataTable(deepHdr, deepVeins, deepCols));
  items.push(para(`DVT (${side}):  None ☐   Acute DVT at: __________________   Chronic changes at: __________________`));

  // SFJ
  items.push(subHead(`${secNum}B.  Superficial Venous System – ${side}`));
  items.push(subHeadItalic("Saphenofemoral Junction (SFJ)"));
  items.push(fieldTable([
    ["SFJ location",       "_______ cm below inguinal ligament"],
    ["SFJ competence",     "Competent  ☐     Incompetent  ☐"],
    ["Reflux at SFJ",      "No reflux  ☐     Reflux: _______ ms  (Valsalva-provoked)"],
    ["Tributaries at SFJ", "Normal  ☐     Accessory saphenous entering  ☐     Other: _______________"],
  ], 32));

  // GSV
  items.push(subHeadItalic("Great Saphenous Vein (GSV)"));
  items.push(dataTable(gsvHdr, gsvRows, gsvCols));
  items.push(para("GSV total refluxing length: _______ cm     GSV wall: Normal ☐   Thickened ☐   Intraluminal echoes ☐   Post-thrombotic ☐"));
  items.push(fieldTable([
    ["AAGSV (Anterior Accessory GSV)","Visible: Yes ☐  No ☐     Diameter: _______ mm     Reflux: _______ ms"],
    ["Giacomini / Posterior Accessory","Visible: Yes ☐  No ☐     Diameter: _______ mm     Reflux: _______ ms"],
  ], 38));

  // SSV / SPJ
  items.push(subHead(`${secNum}C.  Small Saphenous Vein (SSV) & Saphenopopliteal Junction (SPJ) – ${side}`));
  items.push(fieldTable([
    ["SPJ identifiable",               "Yes  ☐     No  ☐   (absent in ~10-30% of cases)"],
    ["SPJ level",                      "_______ cm above popliteal crease"],
    ["SPJ competence",                 "Competent  ☐     Incompetent  ☐"],
    ["Reflux at SPJ",                  "No reflux  ☐     Reflux: _______ ms"],
    ["SSV cranial extension (Giacomini)","Present  ☐     Absent  ☐"],
  ], 38));
  items.push(dataTable(ssvHdr, ssvRows, ssvCols));
  items.push(para("SSV total refluxing length: _______ cm"));

  // Perforators
  items.push(subHead(`${secNum}D.  Incompetent Perforating Veins (IPVs) – ${side}`));
  items.push(note("Pathological criterion: outward flow ≥500 ms AND diameter ≥3.5 mm  (SVS/AVF/AVLS 2023 Guidelines)"));
  items.push(dataTable(perfHdr, perfRows, perfCols));
  items.push(para(`Total pathological perforators identified (${side}): _______`));

  // Varicosities
  items.push(subHead(`${secNum}E.  Varicosities – ${side}`));
  items.push(dataTable(varicHdr, varicRows, varicCols));

  // Skin
  items.push(subHead(`${secNum}F.  Skin & Soft Tissue Changes – ${side}`));
  items.push(dataTable(skinHdr, skinRows, skinCols));

  return items;
}

// ─────────────────────────────────────────────────────────────────────────────
// DOCUMENT BUILD
// ─────────────────────────────────────────────────────────────────────────────
const docChildren = [];

// ── TITLE BLOCK ──────────────────────────────────────────────────────────────
docChildren.push(new Paragraph({
  children: [run("VENOUS DUPLEX DOPPLER ULTRASOUND REPORT", { bold: true, size: 28, color: C.white })],
  alignment: AlignmentType.CENTER,
  spacing: { before: 60, after: 20 },
  shading: shading(C.headerBg),
}));
docChildren.push(new Paragraph({
  children: [run("Bilateral Lower Limb Varicose Veins / Chronic Venous Disease Assessment", { size: 18, color: C.lightBlue })],
  alignment: AlignmentType.CENTER,
  spacing: { before: 0, after: 10 },
  shading: shading(C.headerBg),
}));
docChildren.push(new Paragraph({
  children: [run("SVS/AVF/AVLS 2023 Guidelines  |  2020 CEAP Classification  |  UIP Consensus Document", { italic: true, size: 15, color: C.lightBlue })],
  alignment: AlignmentType.CENTER,
  spacing: { before: 0, after: 80 },
  shading: shading(C.headerBg),
}));

// ── SECTION 1: Patient ────────────────────────────────────────────────────────
docChildren.push(sectionBar("SECTION 1 — PATIENT & REFERRAL DETAILS"));
docChildren.push(fieldTable([
  ["Patient Name",        DOTTED],
  ["Age / Sex",           DOTTED],
  ["Reg. / MRD No.",      DOTTED],
  ["Date of Scan",        DOTTED],
  ["Referred By",         "Dr. " + DOTTED],
  ["Clinical Indication", "Bilateral lower limb varicose veins / leg swelling / leg pain / venous ulcer / pre-treatment mapping"],
  ["Previous Treatment",  "None  ☐    Sclerotherapy  ☐    EVLA  ☐    Surgery  ☐    Specify: " + DOTTED],
], 28));
docChildren.push(emptyPara());

// ── SECTION 2: Technique ──────────────────────────────────────────────────────
docChildren.push(sectionBar("SECTION 2 — TECHNIQUE & EQUIPMENT"));
docChildren.push(fieldTable([
  ["Machine / Model",     DOTTED],
  ["Transducer",          "Linear high-frequency  7.5 – 15 MHz"],
  ["Patient Position",    "Standing / Reverse Trendelenburg  ☐   Supine  ☐"],
  ["Compression Method",  "Manual calf squeeze  ☐   Pneumatic cuff deflation  ☐"],
  ["Valsalva Manoeuvre",  "Yes  ☐   No  ☐   (used for SFJ / CFV assessment)"],
  ["Modes Used",          "B-mode (greyscale)  +  Colour Doppler  +  Spectral Doppler (Duplex)"],
  ["Scan Performed By",   DOTTED],
  ["Interpreted By",      DOTTED],
], 28));
docChildren.push(emptyPara(40));
docChildren.push(new Paragraph({
  children: [
    run("Reflux Threshold (SVS/AVF/AVLS 2023): ", { bold: true, size: 17, color: C.darkBlue }),
    run("Superficial veins & perforators: ", { size: 17 }),
    run(">500 ms", { bold: true, size: 17, color: C.midBlue }),
    run("  retrograde flow.  Deep veins (CFV, FV, POPV): ", { size: 17 }),
    run(">1000 ms", { bold: true, size: 17, color: C.midBlue }),
    run("  retrograde flow.  Pathological perforator: diameter ", { size: 17 }),
    run("≥3.5 mm", { bold: true, size: 17, color: C.midBlue }),
    run(" AND outward flow ", { size: 17 }),
    run("≥500 ms", { bold: true, size: 17, color: C.midBlue }),
  ],
  spacing: { before: 40, after: 120 },
  shading: shading(C.rowAlt),
}));

// ── SECTIONS 3 & 4: Right & Left Limbs ────────────────────────────────────────
buildLimb("RIGHT", "3").forEach(el => docChildren.push(el));
docChildren.push(new Paragraph({ children: [new PageBreak()] }));
buildLimb("LEFT",  "4").forEach(el => docChildren.push(el));

// ── SECTION 5: Reflux Pattern ─────────────────────────────────────────────────
docChildren.push(emptyPara());
docChildren.push(sectionBar("SECTION 5 — REFLUX PATTERN CLASSIFICATION (BILATERAL SUMMARY)"));
docChildren.push(dataTable(
  ["Reflux Pattern", "Right", "Left"],
  [
    ["Axial reflux (groin to calf, uninterrupted)",   "Present ☐  Absent ☐","Present ☐  Absent ☐"],
    ["Junctional reflux only (SFJ or SPJ isolated)",  "Present ☐  Absent ☐","Present ☐  Absent ☐"],
    ["Segmental reflux (portion of truncal vein)",    "Present ☐  Absent ☐","Present ☐  Absent ☐"],
    ["Deep vein reflux",                              "Present ☐  Absent ☐","Present ☐  Absent ☐"],
    ["Perforator-sourced reflux",                     "Present ☐  Absent ☐","Present ☐  Absent ☐"],
    ["Pelvic source suspected",                       "Present ☐  Absent ☐","Present ☐  Absent ☐"],
  ],
  [55, 22, 23]
));
docChildren.push(emptyPara());

// ── SECTION 6: CEAP ───────────────────────────────────────────────────────────
docChildren.push(sectionBar("SECTION 6 — CEAP CLASSIFICATION  (2020 Updated CEAP – American Venous Forum)"));
docChildren.push(dataTable(
  ["Component","Right","Left"],
  [
    ["C – Clinical class",   "C___",   "C___"],
    ["E – Etiology",         "Ep (primary) ☐   Es (secondary/post-thrombotic) ☐   Ec (congenital) ☐",  "Ep ☐  Es ☐  Ec ☐"],
    ["A – Anatomy",          "As (superficial) ☐   Ad (deep) ☐   Ap (perforator) ☐",                   "As ☐  Ad ☐  Ap ☐"],
    ["P – Pathophysiology",  "Pr (reflux) ☐   Po (obstruction) ☐   Pr,o (both) ☐",                     "Pr ☐  Po ☐  Pr,o ☐"],
  ],
  [20, 55, 25]
));
docChildren.push(emptyPara(40));
docChildren.push(subHead("CEAP Clinical Classes"));
docChildren.push(dataTable(
  ["Class","Description"],
  [
    ["C0","No visible or palpable signs of venous disease"],
    ["C1","Telangiectasias or reticular veins"],
    ["C2","Varicose veins"],
    ["C2r","Recurrent varicose veins"],
    ["C3","Oedema"],
    ["C4a","Pigmentation or eczema"],
    ["C4b","Lipodermatosclerosis or atrophie blanche"],
    ["C4c","Corona phlebectatica"],
    ["C5","Healed venous ulcer"],
    ["C6","Active venous ulcer"],
    ["C6r","Recurrent active venous ulcer"],
  ],
  [15, 85]
));
docChildren.push(emptyPara(40));
docChildren.push(para([
  run("Suffix: ", { bold: true, size: 17, color: C.darkBlue }),
  run("s = symptomatic (pain, heaviness, swelling, achiness, itching – HASTI symptoms)   |   a = asymptomatic", { size: 17 }),
]));
docChildren.push(para([
  run("Right CEAP: ", { bold: true, size: 18, color: C.darkBlue }),
  run("C___ E___ A___ P___  ( s / a )          ", { size: 18 }),
  run("Left CEAP: ", { bold: true, size: 18, color: C.darkBlue }),
  run("C___ E___ A___ P___  ( s / a )", { size: 18 }),
]));

// ── SECTION 7: Summary ────────────────────────────────────────────────────────
docChildren.push(new Paragraph({ children: [new PageBreak()] }));
docChildren.push(sectionBar("SECTION 7 — SUMMARY OF FINDINGS"));

for (const side of ["RIGHT", "LEFT"]) {
  docChildren.push(subHead(`${side} LOWER LIMB`));
  docChildren.push(fieldTable([
    ["Deep system",        "Patent ☐  No DVT ☐     Deep venous reflux: Present ☐  Absent ☐   at: _______________________"],
    ["SFJ",                "Competent ☐   Incompetent ☐   Reflux: _______ ms"],
    ["GSV",                "Reflux from __________________ to __________________   Total: _______ cm   Diameter SFJ: _______ mm   BK: _______ mm"],
    ["SSV / SPJ",          "Competent ☐   Incompetent ☐   Reflux: _______ ms   SSV length: _______ cm"],
    ["Reflux pattern",     "Axial ☐   Junctional ☐   Segmental ☐"],
    ["Pathological IPVs",  "_______ perforator(s) at: ________________________________________________"],
    ["Varicosities",       "Distribution: ______________________   Source: ________________________"],
    ["Skin changes",       "None ☐   Pigmentation ☐   LDS ☐   Corona phlebectatica ☐   Ulcer at: ______________"],
  ], 28));
  docChildren.push(emptyPara());
}

// ── SECTION 8: Impression ─────────────────────────────────────────────────────
docChildren.push(sectionBar("SECTION 8 — IMPRESSION"));
for (const [side, n] of [["RIGHT","8.1"],["LEFT","8.2"]]) {
  docChildren.push(new Paragraph({
    children: [run(`${n}  ${side} LOWER LIMB`, { bold: true, size: 18, color: C.darkBlue })],
    spacing: { before: 80, after: 20 },
    shading: shading(C.lightBlue),
  }));
  docChildren.push(new Paragraph({
    children: [
      run(`CEAP: C___ E___ A___ P___ (s/a)\n`, { bold: true, size: 17 }),
      run(`Chronic venous insufficiency, ${side.toLowerCase()} lower limb.\n`, { size: 17 }),
      run("Reflux type: GSV axial ☐   SFJ junctional ☐   SSV reflux ☐   Isolated perforator ☐\n", { size: 17 }),
      run("Reflux from ____________________ to ____________________   Truncal length: _______ cm\n", { size: 17 }),
      run("Deep venous system: Patent ☐   DVT at: ____________________   Chronic changes: ____________________", { size: 17 }),
    ],
    spacing: { before: 40, after: 80 },
    shading: shading(C.white),
    border: { top: { style: BorderStyle.SINGLE, size: 6, color: C.midBlue },
              bottom: { style: BorderStyle.SINGLE, size: 6, color: C.midBlue },
              left: { style: BorderStyle.SINGLE, size: 6, color: C.midBlue },
              right: { style: BorderStyle.SINGLE, size: 6, color: C.midBlue } },
  }));
}

// ── SECTION 9: Recommendations ───────────────────────────────────────────────
docChildren.push(emptyPara(40));
docChildren.push(sectionBar("SECTION 9 — CLINICAL CORRELATION & RECOMMENDATIONS"));
const recs = [
  "☐  Findings support conservative management (compression stockings, lifestyle) for C2/C3 disease",
  "☐  Patient suitable for endovenous thermal ablation (EVLA / RFA) of GSV – Right ☐  Left ☐  Bilateral ☐",
  "☐  Patient suitable for ultrasound-guided foam sclerotherapy (UGFS) of: ___________________________",
  "☐  Phlebectomy / stab avulsions of varicosities advised",
  "☐  Perforator ablation (MOCA / UGFS) advised for IPVs at: _____________________________________",
  "☐  DVT found – anticoagulation and haematology referral recommended",
  "☐  Deep venous reflux present – refer to vascular surgery for further evaluation",
  "☐  Pelvic source suspected – pelvic venous duplex / CT venography recommended",
  "☐  Pre-treatment anatomical mapping complete for planned intervention",
  "☐  Post-treatment follow-up – occlusion confirmed ☐   Re-canalisation noted ☐",
];
recs.forEach(r => docChildren.push(bullet(r)));
docChildren.push(emptyPara());

// ── SECTION 10: Technical Quality ────────────────────────────────────────────
docChildren.push(sectionBar("SECTION 10 — TECHNICAL QUALITY"));
[
  "☐  Technically satisfactory – all segments adequately assessed",
  "☐  Suboptimal assessment of: ____________________ due to: oedema / pain / obesity / wound",
  "☐  Standing position not tolerated; examination performed supine – may underestimate reflux",
  "☐  Images archived to PACS / printed and filed",
].forEach(t => docChildren.push(bullet(t)));
docChildren.push(emptyPara());

// ── Authorisation ─────────────────────────────────────────────────────────────
docChildren.push(sectionBar("AUTHORISATION"));
docChildren.push(fieldTable([
  ["Report Prepared By",   DOTTED],
  ["Qualification",        "MD Radiology / DNB Radiology / DMRD / MS Vascular Surgery"],
  ["MCI / NMC Reg. No.",   DOTTED],
  ["Date & Time",          DOTTED],
  ["Signature & Stamp",    ""],
  ["Centre Name & Address",DOTTED],
], 28));
docChildren.push(emptyPara(60));

// ── Disclaimer ────────────────────────────────────────────────────────────────
docChildren.push(new Paragraph({
  children: [
    run("DISCLAIMER:  ", { bold: true, size: 15, color: C.darkBlue }),
    run(
      "This report constitutes a screening/diagnostic duplex ultrasound examination. A normal study does not exclude all venous pathology. " +
      "Results are position- and technique-dependent; reflux may be underestimated in the supine position. " +
      "All findings must be correlated with clinical history, physical examination, and symptom severity (HASTI). " +
      "References: SVS/AVF/AVLS 2023 Varicose Vein Guidelines (PMID 37652254)  |  2020 CEAP Update (AVF)  |  " +
      "UIP Duplex Consensus Document  |  ACR Duplex Ultrasound Standards.",
      { italic: true, size: 15, color: C.grey }
    ),
  ],
  spacing: { before: 60, after: 60 },
  shading: shading(C.rowAlt),
}));

// ─────────────────────────────────────────────────────────────────────────────
// HEADER & FOOTER
// ─────────────────────────────────────────────────────────────────────────────
const pageHeader = new Header({
  children: [
    new Paragraph({
      children: [run("VENOUS DUPLEX DOPPLER – Bilateral Lower Limb Varicose Veins", { bold: true, size: 17, color: C.darkBlue })],
      alignment: AlignmentType.CENTER,
      border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: C.midBlue } },
      spacing: { before: 0, after: 60 },
    }),
  ],
});

const pageFooter = new Footer({
  children: [
    new Paragraph({
      children: [
        run("Reflux thresholds: Superficial/Perforators >500 ms  |  Deep veins (CFV/FV/POPV) >1000 ms  |  Pathological perforator: ≥3.5 mm & ≥500 ms  |  Page ", { size: 14, color: C.grey }),
        new TextRun({ children: [PageNumber.CURRENT], font: "Calibri", size: 14, color: C.grey }),
      ],
      alignment: AlignmentType.CENTER,
      border: { top: { style: BorderStyle.SINGLE, size: 4, color: C.midBlue } },
      spacing: { before: 60, after: 0 },
    }),
  ],
});

// ─────────────────────────────────────────────────────────────────────────────
// ASSEMBLE & WRITE
// ─────────────────────────────────────────────────────────────────────────────
const doc = new Document({
  creator: "Orris Medical Reports",
  title: "Bilateral Lower Limb Varicose Veins Doppler Report",
  subject: "Venous Duplex Doppler Ultrasound",
  sections: [{
    headers: { default: pageHeader },
    footers: { default: pageFooter },
    properties: {
      page: {
        margin: { top: mm(20), bottom: mm(18), left: mm(18), right: mm(15) },
      },
    },
    children: docChildren,
  }],
});

const OUT = "/home/daytona/workspace/varicose-doppler/Varicose_Veins_Doppler_Report.docx";
Packer.toBuffer(doc).then(buf => {
  fs.writeFileSync(OUT, buf);
  console.log("DOCX created:", OUT);
});

cd /home/daytona/workspace/varicose-doppler && node generate_report.js 2>&1

ls -lh /home/daytona/workspace/varicose-doppler/ && python /home/daytona/skills/…

cd /home/daytona/workspace/varicose-doppler && python3 -c " import zipfile, sys …