Summarize the radiology report findings into an impression within 3 sentences.
    INPUT: Portable supine chest film ___ at 12 :46 is submitted .
    OUTPUT:
    
Given differences in technique , the bilateral diffuse airspace process is not significantly changed . There are likely layering bilateral effusions . Nasogastric tube and left internal jugular central line are unchanged in position . The endotracheal tube now has its tip approximately 6 cm above the carina .