{
  "synthetic": true,
  "patient_id": "PAT-00001",
  "beneficiary_id": null,
  "care_period_id": null,
  "imaging_studies": [
    {
      "study_type": "Carotid Ultrasound",
      "study_date": "2026-06-15",
      "report_date": "2026-06-18",
      "facility": "Desert Imaging Center - Phoenix, AZ",
      "radiologist": "Dr. Jane Smith, D.O.",
      "accession_number": "ACC-20260615-0012",

      "findings": {
        "right_carotid": {
          "im_intima_media_thickness_mm": 1.4,
          "peak_systolic_velocity_cm_s": 85,
          "end_diastolic_velocity_cm_s": 30,
          "plaque_present": true,
          "plaque_location": "Bifurcation",
          "plaque_morphology": "Mixed echogenicity, partially calcified",
          "plaque_max_thickness_mm": 3.2,
          "stenosis_percentage": 40,
          "reversibility": "Partial flow reserve"
        },
        "left_carotid": {
          "im_intima_media_thickness_mm": 1.1,
          "peak_systolic_velocity_cm_s": 70,
          "end_diastolic_velocity_cm_s": 22,
          "plaque_present": false,
          "plaque_location": null,
          "plaque_morphology": null,
          "plaque_max_thickness_mm": null,
          "stenosis_percentage": 0,
          "reversibility": "N/A"
        }
      },

      "impression": "Right carotid bifurcation plaque with moderate stenosis (40%). Left carotid artery unremarkable. Recommend follow-up in 6 months.",

      "source_document": {
        "type": "imaging_pdf",
        "filename": "synthetic_carotid_us_00001_20260615.pdf",
        "s3_key": "synthetic/imaging/PAT-00001/20260615_carotid_us.pdf"
      }
    },
    {
      "study_type": "Liver Ultrasound",
      "study_date": "2026-06-20",
      "report_date": "2026-06-22",
      "facility": "Desert Imaging Center - Phoenix, AZ",
      "radiologist": "Dr. Jane Smith, D.O.",
      "accession_number": "ACC-20260620-0034",

      "findings": {
        "liver_size_cm": 17.2,
        "echogenicity": "Increased — consistent with moderate steatosis",
        "fatty_liver_grade": "Grade 2 (moderate)",
        "focal_lesions": "None identified",
        "biliary_duct_dilation": false,
        "portal_vein_diameter_mm": 11,
        "splenomegaly": false,
        "ascites": false
      },

      "impression": "Moderate hepatic steatosis without focal lesions. No evidence of cirrhosis. Recommend lifestyle intervention and follow-up in 6 months.",

      "source_document": {
        "type": "imaging_pdf",
        "filename": "synthetic_liver_us_00001_20260620.pdf",
        "s3_key": "synthetic/imaging/PAT-00001/20260620_liver_us.pdf"
      }
    }
  ],

  "comparison": {
    "previous_study_date": null,
    "previous_study_type": null,
    "change_summary": "Baseline study — no prior imaging for comparison."
  }
}